COVID-19 adds burdens for hospice care nurses

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The COVID-19 pandemic has taken much from everyday life, but hospice care nurses are doing their best to make sure the virus does not rob their patients of a dignified death. 

 Hospice nurses have long been on the front lines of terminal illness, giving end-of-life care to critically ill patients, but the pandemic has changed the rules.

“We had a record number of admissions and deaths in April,” said Jill Levine, president of Grace Health Care Services. [GHCS]. “I am worried about my staff and the impact that this has had, and will have, on them.”

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The group cares for more than 200 patients in Monmouth and Ocean counties.

Nurses like Eileen Steele, a registered nurse and case manager with GHCS who works at an assisted living facility in Freehold, are often the only persons allowed to see dying patients now that the outbreak has restricted family visits.

“What’s particularly sad is that all of these patients are dying without family members at their bedside because no one is allowed in for obvious reasons,” said Ms.Steele.

Like other hospice care nurses, Ms. Steele tries to fill that void by using technology to arrange virtual visits between patients and their family members, like a FaceTime call she facilitated between a daughter and her dying 93-year-old mother.  

“They die alone without their loved ones at their bedside — this is very unusual,” Ms. Steele said. “This is one of the stresses that we have.”

Debra Cox, nurse and case manager at GHCS, said that Ms. Steele’s experience is now common throughout the state as nurses run themselves ragged to care for those in the last stages of terminal illnesses — which now include COVID-19.

Prior to the pandemic, the average length of hospice care before death was four days for GHCS patients, Ms. Levine said. 

Ms. Cox said it’s common to see elderly patients admitted to hospice care dying within a day or two, due to COVID-19 or its complications.

“I’ve been a nurse for 40 years, and I have been doing hospice for many years and I have never been in this predicament,” she said. “I have never been through anything like this.”  

In normal circumstances, a patient in decline, typically with a prognosis of six months or less to live, would be referred for hospice care by a hospital, an assisted living home or a family. After evaluating the patient and getting consent from the family, patients would be admitted into the hospice service. 

Now, Ms. Cox says, that the process is moving at “100 miles per hour” because of the pandemic. When a patient is recommended for care, the hospice team has to work quickly to get consent and order medication. 

“If they don’t have an email or if they are older and they are elderly, I drive to their house to get consent because we can’t start working with the patient until we have a written consent form,” she said. 

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