The Middletown Press (Middletown, CT)
Hospice patients ‘are dying alone’
Nursing homes restrict visits, caregivers
The coronavirus pandemic may force terminally ill patients to face their last days alone, without the presence of their families and the members of their hospice care team.
Hospitals and nursing homes are not allowing visitors in order to protect patients and staff from exposure to the virus, but the state Department of Public Health has made an exception for patients in end-oflife care. However, limits on the number of visitors and restrictions by nursing homes mean that hospice patients are not able to receive all the services offered by caregivers, according to Tracy Wodatch, president of the Connecticut Association for Healthcare at Home.
“Hospice is a philosophy of care with a full team approach,” Wodatch said Monday. That team includes a nurse, social worker, spiritual counselor, aide, volunteer and physical or occupational therapist, depending on the patient’s needs and desires.
“That team is being challenged right now” because nursing homes are not always allowing access to the patient, for fear of spreading COVID-19. “Some are limiting it to the nurse only,” Wodatch said. This forces the other team members to be creative, using phone and video calls to stay in touch, if the patient is communicative, she said.
Another issue is the requirement that visitors wear masks, gloves, eyewear and other protections when they enter a nursing home, or a private home if the patient’s family insists on it.
“We’re very concerned about running out of personal protective equipment and we’re also very concerned about the patient and family,” Wodatch said. “We’re seeing limits on the visits and some saying you can only come in when a patient takes a turn and is actively dying.”
Since Medicare permits hospice care to anyone who has a prognosis of six months or less to live, this means that caregivers aren’t always receiving access to patients “to help make adjustments in their plan of care,” such as pain-relief medication or physical therapy, Wodatch said.
Not all hospitals and nursing homes are restricting visits in the same way, but limits on outside visits are in place to prevent staff and patients from becoming infected with COVID-19. Wodatch said in addition to limits on visitors, there is often “no hand-holding, no hugging and kissing that you normally would see.”
“We’re really challenged right now to help families deal with the loss of their loved one and know that they’re alone for far longer than you’d hope they would be,” she said.
“I guess ultimately patients are dying alone, which is a sad situation and not something we would want for our patients,” she said.
David Hunter, president of the Mary Wade Home, said visitors are permitted only for terminally ill patients under hospice care but that only nurses are allowed to see those patients and not other members of the hospice team, following guidelines from the Centers for Medicare and Medicaid Services.
“We are not allowing hospice CNAs [certified nursing assistants] to come in because they are in other facilities and we’re worried about cross-contamination” from one nursing home to another, Hunter said.
“As a matter of policy, we are controlling every aspect that we can in our organization,” he said. “This is the most vulnerable population impact by this virus and so we are taking extreme precautions.” He said video links enable patients to communicate with other caregivers.
Mary Wade has suspended communal dining and group activities but has not restricted residents from moving about the building, Hunter said.
Dr. Joseph Sacco, medical director of Connecticut Hospice in Branford, said patients “who are imminently dying” may have “two visitors per day at the bedside,” but they may make just one visit each day. They are not allowed to leave and return.
“We are following the recommendations of public health authorities at the level of the CDC and the level of the state,” Sacco said. Connecticut Hospice is licensed as a 52-bed hospital and may only offer inpatient hospice care to patients who are near the end of life and who “also must have a level of care needs that cannot be managed in another setting,” he said.
Connecticut Hospice also contracts with Yale New Haven Hospital to admit patients who are eligible for the Medicare hospice benefit but who are not so ill that they require inpatient care, Sacco. Those patients, while staying at hospice, are treated as hospital patients and may receive no visitors, he said.