Hospice rules evolving in time of pandemic

Hospice rules evolving in time of pandemic



Local hospice providers are making sure patients spend their final days with loved ones even as the coronavirus pandemic prompts changes to visitation rules.

“Our staff is amazing and they never wavered. They were committed and understood from the beginning that these folks … certainly deserve to die with dignity and have their loved one present,” said Laura A. Marion, RN, BSN, assistant vice president, Allied Services Hospice and Palliative Programs.

The COVID-19 pandemic has forced health care providers to implement restrictions across the industry to stop the spread of the virus. Nurses and doctors are often the last people that patients — with and without the virus — spend their final moments with.

“Dying with dignity” is a phrase used across hospice and palliative care. Providers are striving to provide that essential service while limiting visitors and using telehealth and video chatting apps to keep their employees safe and patients comforted.

“Hospice is such an intimate part of health care, and there’s a lot of touching and personal contact. It has been difficult,” said Diane Baldi, CEO of Hospice of the Sacred Heart.

Sacred Heart developed a COVID-19 questionnaire for staff and families. They’re using telehealth when they can for their home patients and are allowing only one person per visit in their hospice center.

“We try to see patients we can in dire need as long as everybody is clear and everybody is safe,” Baldi said. “Otherwise it’s telehealth visits, which has been hard on the staff and patients and families. Thank God for FaceTime and anything we can do that could help with that personal connection.”

Allied screens all staff and patients and increases infection control policies at the hospice center, Marion said. Visiting family members are limited to two per patient.

“First and foremost we protect our staff, because we can’t deliver care if my staff gets wiped out,” she said.

Allied, with positive cases of COVID-19, isolated three rooms. Patients and families sometimes must use personal protective equipment.

Sacred Heart has no cases of the virus at its inpatient unit but does have COVID-19 patients in long-term care nursing facilities.

Both hospices are continuing care at family homes.

“Hospice is a very hands-on type of nursing that requires an immense amount of education and support, which can’t always be delivered through a video message,” Marion said. “We are still doing face-to-face visits for all of our hospice patients, even our COVID patients.”

Allied is seeing an increase in referrals.

Marion said Allied has noticed two trends. First is patients who have contracted COVID-19 and are not recovering, greatly changing their prognosis or how long they have to live. The second is COVID-19 exacerbating an illness that patients already had.

Cathy Cassidy’s mother, Dorothy Wangberg, was in the care of Allied Hospice in the midst of the pandemic.

While Wangberg was at Allied’s Skilled Nursing Facility, the family was not able to visit her.

Working with Allied Hospice, the family was able to move Wangberg back into her home at Lake Ariel, where she died at 102 on April 20 surrounded by her family.

“When hospice first got involved our thought was that, if she was on her last breath maybe we’d be able to get in to see her,” Marion said. “They explained everything to us. It made all the difference between a nightmare, which is what we were living before this, and knowing that my mother was surrounded by her family and we had the support we needed to be able to just focus on her.”

Allied was also available 24 hours a day to answer any of the family’s questions.

“She had a wonderful, long life and she lived it well, and she had a beautiful death, which is thanks to hospice,” Cassidy said.

A silver lining to the pandemic is that most family members are now working from home or remotely, Baldi said.

“In the past 10 years, maybe longer, the caregivers weren’t always in the home, but now they are,” she said. “What we have found is families do want to take care of loved ones. It can be frightening for caregivers and we’re making sure to calm them down and support them through all this.”

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