Four Essentials: What Hospice Taught Covid-19

What We’ve Learned, We Already Knew


Submitted by Sharon Davidson, Big Bend Hospice Director of Volunteer & Community Services
Co-Writers: Lisa Baggett, Community Engagement Coordinator & Ryan Thompson, MSW, Transition Counselor

As the bell curve of the pandemic appears to be on the decline, many industry leaders and politicians have been asking, “What has Covid-19 taught us?” It’s an important question to ask but hospices, including Big Bend Hospice (BBH), have consistently focused on and developed standards on several things that rose to greater importance over the past year: Hand hygiene, social support through volunteers, advance care planning, and the role of essential workers.

Hand hygiene has always been a critical step in impeding the spread of infections. Since 1983, every new Big Bend Hospice employee and volunteer, under the direction of the Infection Control department, has been provided instructions on the proper way to wash their hands with soap and water and how to properly dry the hands to remove bacteria and other harmful substances which can cause cross-contamination or illnesses. It has been interesting over the past year to see the use, or rather mis-use, of people wearing gloves. It was common to see cashiers handling products and money, never changing their gloves between customers. It would have been more sanitary for them to simply use an alcohol-based hand sanitizer between each transaction, another practice taught in the healthcare field when soap and water are not available.

As Julianne Holt-Lunstad wrote in a blog post on the “double pandemic” of social isolation and Covid-19 for the Health Affairs website, “being socially connected in meaningful ways is actually key to human health and survival.” Hospice, especially community providers like BBH, has long recognized that illness shouldn’t condemn someone (including caregivers of the patient) to isolation. Volunteers are a vital component to the caring of the sick and aging, and help ward off feelings of loneliness. Medicare and Medicaid knew the importance of having trained hospice volunteers when they set up the Conditions of Participation. They require 5% of all direct patient care be provided by a trained volunteer. During the peak of the pandemic, many hospice patients and Transitions clients continued to request volunteer assistance. Even when no in-person visits could be conducted, volunteers made telephone calls and wrote special notes to patients and their families. This was vital for people to stay connected when so many were feeling alone. During 2020, BBH Trained Volunteers provided over 5,300 hours to patients and families.

In 2014, BBH introduced PEACE (Planning Early About Care at the End of Life). The purpose of the program is to encourage people to do advance care planning, including completing a Five Wishes document to share with their family and medical providers. Having a plan makes it easier for loved ones to put your care and treatment preferences in place when you cannot make these decisions for yourself. Some who have been diagnosed with Covid-19 experienced acute respiratory distress. Many were rushed to the hospital where they underwent a tracheostomy (an incision in the windpipe made to relieve an obstruction to breathing.) Later, the nation learned “almost one out of four tracheotomized patients died from COVID-19.(Nature Public Health Emergency Collection, Aug 4, 2020.)

People began talking about having a “plan” of what their choices would be should they find themselves in this or other medical situations. BBH encourages everyone, regardless of age, to do advance care planning, including documenting their choices in an advance directive like the Five Wishes document. The Five Wishes is a simple, straightforward living will that allows you to express your medical wishes as well as your personal, emotional, and spiritual needs.

Finally, nurses have always been heroes! BBH didn’t need a pandemic to understand Nurses are essential. These front-line workers, from CNA to LPN to RN to ARNP, illustrated their selflessness during this past year’s public health crisis by providing direct patient care at the risk of exposing themselves to the virus. They have always dedicated their heart and soul to taking care of patients, even in the most stressful circumstances. Their devotion to their patients is seen through the time and energy they give, whether that’s helping them understand their treatment options, explaining medication and side effects, or sharing what they can expect as a patient’s condition progresses. Nurses are indeed heroes!

While Covid-19 may have brought Zoom, Door Dash, and Amazon deliveries to the forefront, Big Bend Hospice and others in the healthcare industry have always known the importance of good hand hygiene, community support by trained volunteers, having advance directives in place, and nurses on the front line.

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