Best Practices for Using Telehealth in Hospice and Palliative Care

Michelle Webb, DNP, RN, BC-CHPCA; Susan Lysaght Hurley, PhD, GNP-BC; Jennifer Gentry, DNP, ANP-BC, GNP, ACHPN; Melanie Brown, LCSW; Cynthia Ayoub, BSN, RN, BC-CHPCA


Journal of Hospice and Palliative Nursing. 2021;23(3):277-285. 

In This Article

Accelerated use of Telehealth During the COVID-19 Pandemic

Although telehealth technology and related research have grown dramatically over the last decade in home health care and other post–acute care settings, there has been a slower uptake of telehealth in hospice and palliative care presumably related to the numerous barriers earlier described. The COVID-19 pandemic has been a catalyst for rapid acceleration of the use of telehealth to provide hospice and palliative care, especially in all settings.

Telehealth has quickly gained recognition as an essential service to limit the spread of COVID-19, as well as to conserve valuable and limited personal protective equipment.

A 2020 National Association of Home Care & Hospice survey found that more than 95% of responding hospices reported that existing patients had refused visits because they feared exposure to COVID-19.[27] In many long-term care facilities operating under pandemic-related regulations and restrictions, hospice providers are viewed as nonessential visitors, and some have been unable to gain access to provide in-person services.[28] For family caregivers who are excluded from visitation in long-term and acute care facilities, virtual access can provide access to loved ones and to the providers caring for them.[29]

The COVID-19 pandemic generated a need for many psychosocial and spiritual care providers (social workers, chaplains, music therapists) to provide a majority of their services via telehealth, in many cases with added support from nursing team members, who are among those consistently allowed to perform in-person visits in facility settings.[29]

Given the aforementioned ways in which in-person contact with patients and families has been limited during the COVID-19 PHE, hospice and palliative care provider organizations have been faced with an immediate need to implement telehealth, often for the first time. In 2007, there were 695 hospice agencies, of which 6% were using telehospice.[18] While no recent equivalent comparison of total percentage of hospices using telehospice is available, a 2020 National Hospice and Palliative Care Organization survey found that 92% of hospices reported provided more care using audio/visual technology in the first half of 2020, compared with the same period last year (Edo Banach, electronic communication, July 31, 2020). More than 90% of respondents to National Hospice and Palliative Care Organization's 2020 Palliative Care Needs Survey reported providing telehealth services in all of the various care settings where palliative care services are provided.[30] A National Association for Home Care and Hospice survey conducted in May 2020 revealed that 2-way audiovisual communication was being used by 82% of respondents during the time of COVID-19.[27] In the early days of the pandemic, a survey of patients and families of various ages and health status found that overall satisfaction with telehealth care was high, with some respondents reporting a willingness to switch providers to have access to these services.[31]