The Changing Face of Palliative and Hospice Care Post-COVID

We are a little over a year into the global COVID-19 pandemic. Since the start of the pandemic last year, we have seen a profound impact on the palliative and hospice care industry. Changes in care due to public health orders, increased demand for medical supplies, and the mental health of staff everywhere have impacted healthcare providers around the world. The hospice and palliative care industry has been heavily impacted by the pandemic.

Hospice and palliative care have long treated vulnerable populations, making this industry resilient. However, that doesn’t mean that we’ve been unscathed in the light of COVID-19. David Walsh, CEO, had this to say about how Hospice of Southwest Ohio was impacted directly. “We have endured but not prospered. We’ve seen high costs for equipment and supplies and increased need for paid time off for staff. We have to find new ways to support our staff with the added personal and professional stress they are facing. Our providers had to adopt telehealth technology in order to continue to provide care. We’ve seen a shift in referrals to hospice as families avoided institutionalization. Every aspect of our operation has been impacted.”

This industry has always been one that is ever-evolving due to regulation and policy changes but the COVID-19 pandemic has shaped the future of care in new ways.

A Q&A With Our Care Providers

In order to better understand the changing face of care, we asked our Director of Clinical Services Lori Revis, and Hospice of Southwest Ohio and Carebridge Services Medical Director Dr. Richard Sternberg some questions about changes they’ve seen in care due to the pandemic.

How was an in-home hospice visit handled before the pandemic versus how it was handled during and after mask mandates were lifted?

Lori Revis: Staff have always adhered to Universal Infection Control precautions now and prior to the pandemic. During the pandemic and even now, all staff wear a mask and use universal infection control procedures. All patients and families are screened prior to admission and prior to visits according to CDC guidelines. Our staff self-monitor each day for any symptoms of COVID-19.

Dr. Sternberg: The pandemic forced us to rethink our approach to in-home visits. Many patients were wary of caregivers in the home, thus we required all our providers to take full precautions, including full PPE in order to give patients security during the visit.

Explain how hospice in the care center shifted during the pandemic and how it will evolve as restrictions continue to lift. When will volunteers return? What changes will remain in place in the post-COVID environment?

Lori Revis: The Care Center requires screening for COVID-19 for all patients and visitors prior to admission. At the beginning of the pandemic, visitors were limited to in-room visitation only with only two visitors allowed per patient. We now allow multiple visitors but masks and screening are still required. The Care Center does not admit COVID-19 positive patients. All staff wear masks and visitors are required to wear masks. It is unknown at this time when our volunteers will be permitted to return.

Dr. Sternberg: Care Center care did not change. What changed was our screening of patients coming from hospitals, visitors, and staff. As restrictions are lifted, we will continue to monitor anyone who displays signs and symptoms of infection, continue to wear masks, wash hands frequently, etc. As the Delta variant surge is still unknown, it is unclear when volunteers will return.

How was an in-home palliative care visit handled before the pandemic versus how it was handled during and after mask mandates were lifted?

Dr. Sternberg: Prior to the pandemic, there were no barriers from a health standpoint for in-home palliative care visits. During the pandemic, however, we had to conduct most visits via telehealth technology. At this point, we have reinstated in-home visits with our vaccinated nurse practitioners and staff members. We will continue to require masks, wearing gloves if warranted, and handwashing pre and post visit.

How will palliative care change moving forward in the post-COVID environment?

Dr. Sternberg: Palliative care should continue to grow as the population ages and more people will have chronic disease issues. The resolution of the pandemic will make it easier for protected in-home patient visits.

What were the biggest challenges you faced as a caregiver during COVID?

Lori Revis: Our staff has faced many challenges in the past 15 months. Hospice is all about the care, touch, and connection with the patient, family, and caregiver. We were connecting via phone, Facetime or Backline (our HIPAA-compliant telehealth portal) but we weren’t physically there to comfort that family member or loved one who needed our support. Our social workers and chaplains who traditionally provide emotional support could not enter facilities. The inability to be there in person for their patients and families took an emotional toll on our staff. I think all our staff felt some type of compassion fatigue as a result of COVID-19. It was, and still is, a priority for the management staff to support our staff in the field.

Dr. Sternberg: As a provider, I had to be extra careful to protect myself in order to ensure that I was not a risk to the patient. Providing excellent care in an uncertain environment has also been a challenge.

Human connection is critical in hospice and palliative care. As a caregiver, how did you adapt to the restrictions?

Dr. Sternberg: Human connection with our patients never changed, only the medium we used to provide the care.

What would you tell a family member who is considering palliative or hospice care for a loved one?

Lori Revis: Our number one goal is symptom management and pain control to help our patients be as comfortable as possible. We provide not only emotional support for the patient but also their family and loved ones. There are so many benefits that hospice care offers — supplies, equipment, RNs, social workers, home health aides, and chaplains. Often, hospice is initiated too late in the illness and patients and families don’t get to receive the maximum benefits from hospice. Family members often comment that they wish they had started hospice sooner in the patient’s illness.

Dr. Sternberg: Palliative care is an added layer of support for anyone experiencing the challenges of a chronic illness. Hospice care is end-of-life support — emotional, physical and spiritual — to ease the suffering and pain of a terminal illness.

How would you reassure someone that their loved one would be safe but still receive loving and compassionate care?

Lori Revis: Our staff continues to adhere to CDC guidelines — masks are worn, COVID testing protocols are in place, and the majority of our staff is fully vaccinated against COVID-19. Visits to patient homes are not limited but we are still seeing some restrictions in facilities. We will continue to use the technology and innovations that we learned early in the pandemic to connect with patients and families when restrictions are in place.

Dr. Sternberg: The providers at CareBridge Services and Hospice of Southwest Ohio are empathetic, family-oriented, caring people who strive every day to improve their patients’ lives in a safe manner by using common sense precautions and following all appropriate medical guidelines.

Do you see some COVID-type restrictions remaining in place moving forward in patient care?

Lori Revis: I believe that with the increase in the Delta variant and continued positive COVID-19 cases, we will continue to see various restrictions and mask mandates according to positivity rates and outbreaks in facilities and in the community.

Dr. Sternberg: I think common sense precautions and Ohio Department of Health and CDC guidelines will remain. For now, we will continue wearing masks and gloves when examining patients at risk, handwashing, and utilizing full PPE with select patients who are positive for COVID-19. We will also continue to use COVID tests to mitigate spreading the disease.

Comfort and Compassion, No Matter What

The pandemic continues to impact how we live, and die. We will continue to see shifts in care trends and changes in how care is provided. What doesn’t change is the compassion and comfort that we seek to provide patients and their families. Both Carebridge Services and Hospice of Southwest Ohio are made up of multidisciplinary teams of healthcare professionals who work together to help patients bring life back to their final days.

At Hospice of Southwest Ohio, we’re proud to be your hometown hospice choice. We have an amazing team of professionals who are passionate about delivering high quality, compassionate care every day. HSWO offers hospice, palliative and in-home primary care in and around the greater Cincinnati area in Clermont County, Butler County, Warren County and Hamilton County. Call today at (513) 770-0820.

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