COVID-19: Opening Doors and Hearts to COVID-Positive Patients
Setting policies and procedures for inpatient units during the COVID-19 pandemic represented one of the most challenging issues for hospice providers across the country. With both freestanding hospice inpatient care centers and units housed within area hospitals, Ohio’s Hospice needed to create policies not just to ensure the safety of patients, staff and visitors, but also to respect the policies of host hospitals, as appropriate, follow the known science, and reflect the special circumstances of caring for patients with a limited time to live.
Whether to admit COVID-positive patients was one of the first and most critical questions hospices faced. For Ohio’s Hospice, the answer was: “Of course.” This proved to be as important to area hospitals, skilled nursing and assisted living facilities as it was to hospice patients and their loved ones.
Christy Michaels, MSW, LISWS, APHSW-C, director of Clinical Operations at Ohio’s Hospice LifeCare, reports that their leadership team reached out to the local hospital and assured them that they would be willing to take COVID-positive patients. “If there’s an overflow (of COVID-positive patients), we want to help out any way we can,” Michaels says. “We kept our census low in our inpatient unit just so we’d be able to help out.”
Ohio’s Hospice created isolation units for COVID-positive patients within its inpatient care centers. At a large freestanding care center like Ohio’s Hospice of Dayton, that was a matter of isolating an entire hallway. At a smaller inpatient care center, like at Ohio’s Hospice LifeCare in Wooster, Ohio, welcoming COVID-positive patients was a matter of designating a handful of isolation rooms at the end of a hallway.
To provide the care to COVID-positive patients, Ohio’s Hospice asked for nurses and nursing assistants to volunteer to care for those patients, according to Yvonne Turner, vice president of Clinical Care and chief nursing and care officer for Ohio’s Hospice of Dayton. Social workers and chaplains were allowed on the isolation units only on an as-needed basis, Turner explains, with telehealth visits offered to patients and families as an alternative. For everyone’s safety and well-being, volunteers were not permitted inside the inpatient care centers, she adds.
Although visitation never was shut down entirely, visitation policies were tightly restricted in the early months of the pandemic and then gradually loosened as more was learned about how the virus is transmitted and as PPE became more readily available. “It was crucial that whatever visitation policies we put into place, they not only provided safety for patients and staff but also allowed us to honor patients at the end of life and allowed them to have as much closure at end of life as possible,” Turner says.
That generally meant only one designated visitor, following strict guidelines for donning and doffing PPE under staff supervision, was allowed for the duration of a patient’s stay. Since visitors were not allowed to leave and return the same day, Ohio’s Hospice provided meals for visitors to enjoy in the patient’s room.
To facilitate video calls with other family members and friends, every patient had access to Ohio’s Hospice-supplied iPads. To make it easy for visitors to have “window visits” with patients, Ohio’s Hospice placed a location ID on the windows of each room so loved ones could easily find a patient’s room.
As much as has been done, there’s more that can be done, Wagner notes. “I was at Ohio’s Hospice of Dayton one day. It was raining. I saw someone with an umbrella standing outside a window in the rain. This was possibly the last time this person would see their loved one. It was so emblematic of what the community was going through. And it reaffirmed for me we have to find ways to do more.”