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How Has Hospice Changed?

During this incredibly complicated and dark time, we are facing an enemy that we cannot see, and can do very little to combat. Despite the countless efforts from healthcare workers, scientists, grocery store workers, and many more, we have still suffered tremendous losses, especially within our elderly population. In fact, our whole lives have been turned upside down. Social distancing, mask wearing, temporary and permanent business closures, professional sporting events cancelled, school closures, and pretty much every other aspect of life has been impacted in some way, shape, or form. Today we will be looking at hospice, one sector of healthcare familiar with sorrow, and how they must adapt to the ever changing COVID-19 guidelines.

Lets begin with what exactly is hospice? Hospice care has been around since the 1800’s, but was not officially founded until 1974. The priority of hospice is to promote and achieve the best quality of life possible. Quality of life is a broad and complex aspect of healthcare that is difficult to understand. A common example would be if a patient is nearing their final days and they begin to experience pain and discomfort. In this situation, the hospice personnel would make it their primary goal to reduce the discomfort and make them as comfortable as possible. Hospice personnel consists of aides, nurses, doctors, chaplains, and others. One common misconception I have found with hospice is that people not familiar with the service think that they are there to improve the patient's health conditions. Some believe they are there as a last resort to improvement, not to make them comfortable, which is incorrect. Realizing that their loved one is in fact terminally ill can be an incredibly emotional experience for the family. Hospice is also responsible for making sure the family is fully aware of the situation and what action needs to be taken to keep the patients best interests in mind, not the family’s.

Now let's discuss the normal hospice procedures before the arrival of COVID-19. Hospice care usually consists of visits throughout the week, usually multiple times. Visits can range anywhere from 30 minutes to 2 hours, depending on the patients needs and requirements. There are four commonly used types of care that define the level of care needed. The most common level is routine home care. This level is the most basic, and provides the typical support needed to improve the quality of life as much as possible.The next level of care is continuous home care. This level requires nursing staff to stay in the patient's home for an extended period of time. This would be due to an emergency medical condition, such as extreme and uncontrollable pain, shortness of breath, and other conditions that need to be closely monitored. If these conditions advance to a certain level, the physician or nurse may move them into the next level of care, which is general inpatient care. General inpatient care is more suited to handle these extreme cases in an inpatient facility. The goal is to get them in the facility to treat them, then get them back home as soon as the conditions are under control. The last level of hospice care is respite care. Respite care is occasional, typically around 5 days, and usually offered as a break for loved ones who are taking care of the patient. This care takes place in nursing homes and other inpatient facilities.

So how has hospice had to adapt to our current situation? After all, end of life care is still absolutely essential and cant be shut down or slowed like restaurants and sporting events can. One obstacle hospice personnel face today is being able to access facilities and homes. Nursing homes and assisted living facilities are asking that only one nurse be allowed in the building, so nurses and aids are being designated to specific facilities. This means that patients are being transferred between nurses to accommodate for their rules and guidelines. Other personnel like social workers and chaplains have also been barred from entering facilities or visiting patients that are still at home. One alternative that has become increasingly popular across all aspects of life, from school, to jobs, and countless others, is the use of technology. More specifically, apps like zoom, facetime, and webex have allowed for telehealth visits with incredible flexibility and convenience for all parties. Another problem that also plagues the rest of the world is lack of equipment. Especially at the beginning of the outbreak, masks were few and far between, as were gloves and gowns. Hospice’s still face shortage of PPE, cleaning supplies, and most recently, a shortage of oxygen. Other than wearing masks and socially distancing, hospice personnel have been faced with the challenge of providing high quality end of life care amidst a cluster of unfamiliar rules and guidelines.

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