Guidelines help to protect everyone
By Amy Wolff Sorter
Area hospices accredited by the National Institute for Jewish Hospice — Anchor of Hope, Faith Presbyterian, The Legacy at Home and Visiting Nurses Association (VNA) — have had to adjust their practices in caring for their patients and their patients’ families throughout the coronavirus pandemic.
Health and safety are paramount. Staff is taking appropriate measures to ensure their own safety, and the safety of clients and their families. These measures range from frequent temperature checks and temperature logs by those in the field, to appropriate personal protective equipment (PPE), to strict adherence to facility guidelines
Elise Power is manning the front desk at Faith Presbyterian Hospice, where she works as Jewish hospice community liaison. She takes the temperature of someone wishing to visit a hospice patient at the Pickens’ Center on-site care facility. Family members are allowed to visit only patients with a seven-to-10-day prognosis, with two visitors per patient. “Ninety-eight-point-six,” Power says to the visitor. “Don’t forget your mask, and have a good visit.”
Mandating masks and taking visitors’ temperature readings are becoming very routine just about everywhere, and hospice agencies are no exception. “Everyone has to be screened,” Power said. “When funeral homes come to pick up patients that have passed, they have to be screened, as well.”
Hospice care at The Legacy at Home also rests on multiple temperature checks per day, with “any employee who registers over 99 degrees reviewed by a panel of our leadership to determine next steps,” said Jessica Haecker, the organization’s executive director. When it comes to visitors to the facility, screened visitors are allowed to visit end-of-life patients, which is a state regulation. “Typically, these patients would be people who, according to their signs and symptoms, would have only a few days,” Haecker noted.
Olivia Rogers, the VNA’s vice president and chief nursing officer, explained that, as a Medicare-certified agency, “we are required to have a robust emergency preparedness plan in place.” The plan includes a focus on five daily tasks consisting of patient screening, staff screening, PPE staff education, PPE usage and risk mitigation.
Risk mitigation and social isolation are very important when it comes to care of hospice clients, because not all those clients are nearing end of life. “Some of our patients have end-stage heart or lung disease, and might have months, or even years, to live,” Rogers said. “We don’t want to expose them to someone that might have the virus.”
Anchor of Hope was prepared long before coronavirus cases escalated in the United States. “Before COVID-19 came to the U.S., our director of nursing was already making preparations,” said Eileen Rians, the hospice’s community liaison. “She had everyone on our staff take their temperatures and fill out on a daily basis.” Furthermore, the advanced preparation meant Anchor of Hope had plenty of gloves, masks and PPE. When the masks ran out, “one of our social workers, a very talented seamstress, found instructions for masks she could make,” Rians said. “It’s triple-layered, with a filter in it.”
Having the correct PPE and risk mitigation strategies is only one part of the challenge of dealing with COVID-19. The agencies serve patients and their families in different facilities throughout the metroplex, meaning different requirements that need to be followed. “In many of the hospitals and skilled nursing centers, you can’t go in and be with the patients, and family members can’t visit them their either,” Power said. “You have to follow the guidelines of the facilities.”
The situation is a little less restrictive for in-home care, but even in this case, CDC guidelines are necessary. When visiting homes with COVID-19-diagnosed patients, staff are required to wear gowns, gloves masks and face shields. For the staff visits that can’t be conducted in person, telehealth and Zoom meetings have been useful, to an extent. And, when it comes to visitation, Haecker explained that FaceTime, video chats and pictures are being used quite frequently.
But technology hasn’t always worked. “I’m the one who deals with the legal paperwork,” Rians commented. “But many of the older people don’t understand computers, so I end up making the rounds, and putting hard copies in their mail boxes.” In one situation, she said, she conducted an in-take, with the client in her house, Rians seated on the porch, and questions and answers delivered through a closed door. “We’re finding creative ways to do this,” Rians said.
Even amid the measures and technology used to assist those in hospice care and their families, there is one thing lacking. “In normal times, physical touch is so important at this time,” Rogers said. “That lack of touch, of a hug, a hand on the shoulder in comfort, is hard for families.” Rogers went on to say that the VNA is trying, within its means to replicate that sense of touch, one of which is pillows being made by volunteers. “This is a kind of hug we can deliver to everyone’s home,” she said.
Haecker indicated that The Legacy at Home is also trying to work around the problem of human touch. “Research shows human touch is vital to help reduce depression and stress,” she said. “Now that we’re living in a climate in which touch is being discouraged and, in some cases, not allowed, we are having to get creative to overcome the deficit.”
And, the lack of touch is also difficult for the staff. “That’s the thing I think that hurts me,” said Rians, who classifies herself as a “huggy” individual. “Prior to all of this, I was the person who would first go to meet the family, and would be personally invited into their homes and communities. But we can’t do that anymore.”
Still, hospice agencies, and their staff continue working around the issues, and ensuring clients and families get the care they need. “It’s been more challenging, but I think we’ve adapted,” Power said. “We’re making it work, within those challenges.”