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COVID-19 is one of the major global disasters of the 21st century. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a global pandemic. A pandemic and public health emergency (PHE) was declared in the United States on March 13, 2020 (Centers for Disease Control and Prevention [CDC], 2022a). Coronavirus disease (COVID-19) is an infectious disease caused by the SARS-CoV-2 virus and is transmitted from an infected person’s mouth or nose in small liquid particles when they cough, sneeze, speak, sing, or breathe (CDC, 2022b).
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NOTE
Administration for Strategic Preparedness and Response (ASPR) Declarations of a Public Health Emergency (PHE) – Web page containing the declarations of all federal public health emergencies. (https://aspr.hhs.gov/legal/PHE/Pages/default.aspx)
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The COVID-19 pandemic has caused an unparalleled healthcare crisis in the US, generating extreme stress on the healthcare workforce and leading to workforce shortages as well as increased healthcare worker burnout, exhaustion, and trauma. These pandemic-related challenges exacerbated workforce shortages, staff burnout, stress, and mental health problems (including an ongoing risk of post-traumatic stress disorder) that were already significant issues before the pandemic. As a result of the pandemic, many types of healthcare workers have left healthcare as a profession (Assistant Secretary for Planning and Evaluation, 2022).
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In April 2020, the Centers for Medicare & Medicaid Services (CMS) enacted several temporary 1135 blanket waivers that gave healthcare providers the extra flexibility required to respond to the COVID-19 pandemic (CMS, 2023)
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When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act and the Health and Human Services Secretary declares a PHE under Section 319 of the Public Health Service Act, the Secretary is authorized to take certain actions in addition to their regular authorities (CMS, 2022). Many of the 1135 blanket waivers for hospice lessened restrictive regulatory requirements related to conditions of participation and other certification requirements so they could continue to admit and provide care in a safe manner to patients and families. CMS also made two of the hospice aide waivers permanent in the FY 2022 Hospice Payment Rate Update Final Rule (CMS, 2021).
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The COVID-19 PHE declaration has been renewed many times since the original declaration in early 2020 (ASPR, n.d). A presidential announcement in January 2023 stated its intent to end the national emergency and public health emergency declarations on May 11, 2023, related to the COVID-19 pandemic. This means that all flexibilities were retracted unless they were made permanent.
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DIRECT IMPACT OF THE PANDEMIC ON HOSPICE CARE
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In the early days of the pandemic, hospice providers experienced shortages of personal protective equipment, decreased access to patients and families (particularly in nursing facilities), patient flow through hospice care settings was blocked or delayed, and workforce availability was severely ...