As more people are hospitalized due to COVID-19, are health care systems, patients, and families prepared for tough conversations and decisions about health care preferences and medical interventions? Now more than ever, it is important for providers to tap into the core tenets of palliative care to guide patients and their families through uncharted waters.
“This pandemic means that we will be drawn into countless conversations with families who are suddenly having to make difficult decisions about life and death,” Nathan Gray, MD, a palliative care specialist at Duke University Hospital, wrote in a comic book–style story that he illustrated. “As we take stock of masks, gloves, and ventilators, we must also be ready to dig deep into our reserves of patience, communication, and compassion.”
In a Washington Post commentary, Emily Aaronson, MD, an emergency physician and assistant chief quality officer at Massachusetts General Hospital, encouraged families to engage in conversations about end-of-life wishes now. “It’s important that you understand what would be most important to them if they were in the last phase of their life — and what steps you and others will have to take to ensure those needs are met,” Aaronson wrote. “These are conversations designed to guard against regrets.”
The Struggles Of COVID-19 Impact Hospice Organizations Providing Care
Each and every day, MJHS Hospice nurses, social workers and chaplains crisscross New York City to provide compassionate, dignified and respectful end-of-life care to the most vulnerable New Yorkers at home, including those who are COVID-19 positive or exhibit COVID-19 symptoms. Home hospice programs like MJHS are in greater demand than ever because area hospitals are increasingly desperate to free beds for critically-ill patients.
Amid the tenderness and stillness, skin-to-skin holding of hands is no longer done, family members and friends do not gather around a bed to say goodbye together, and nurses must be fully suited in PPE (personal protective equipment) if a patient exhibits, or is suspected of having, any COVID-19 symptoms. Music and art therapy are conducted by phone, FaceTime, Zoom or Skype. Family and friends attend gravesite burials virtually. Bereavement counseling is virtual or by phone.
The entire MJHS Hospice clinical team faces the unknown every day. Because there are not enough COVID-19 tests, hospice clinicians rarely know if the patient they are about to care for – or a member of the patient’s household – has COVID-19.
While hospitals and nursing homes are on the Office of Emergency Management list to receive PPE, hospice and home care organizations are not. With dwindling supplies of PPE in New York City, and despite our commitment to the hospice mission, the time will soon come when MJHS Hospice will no longer be able to handle the growing number of hospice referrals because we simply will not have the appropriate protection to keep our clinicians, our patients and their loved ones as safe as possible.
MJHS Hospice is committed to caring for COVID-19 patients and remaining an integral part of the response effort. An increased supply of PPE will allow the organization to continue doing so. Hospice, even in the era of the current pandemic, can be a beautiful and loving experience.
About MJHS Health System
The roots of MJHS date back to 1907, when four courageous Brooklyn women saw people in desperate need of care and loving kindness. Based on the core values of compassion, dignity and respect, and with the help of charitable support, they provided poor, elderly members of the community with quality health care and a safe place to live.
The organization they founded has expanded from one small building among the tenements to one of the largest not-for-profit health systems in the region providing home care, hospice and palliative care for adults and children, Isabella and Menorah Centers for Rehabilitation and Nursing Care and the research-based MJHS Institute for Innovation in Palliative Care. It also includes Elderplan, which offers health plans for Medicare and Dual Eligible beneficiaries and its managed long- term care plan, HomeFirst, one of the original MLTC plans in New York.
Many MJHS Health System programs and services are aided by grants from MJHS Foundation, which is supported by private and corporate donations, as well as grants.
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Lisa Remington is president of the Remington Health Strategy Group and publisher of the Remington Report magazine and has worked with more than 6,000 organizations in both a consultancy role and educator. Lisa monitors the complex key trends and forces of change to develop a correct strategic approach to de-risk decision-making and create sustainable futures across the healthcare continuum.