HJNO May/Jun 2021

Q&A 30 MAY / JUN 2021 I  HEALTHCARE JOURNAL OF NEW ORLEANS   like giving an infant a syringe full of Tyle- nol. Most people are OK with giving medi- cation to an infant and hopefully will see the similarities. In your experience, do you find forced end-of-life gatherings or goodbyes with estranged family helpful for the patient? Does the answer change if the dying feels wronged by the family members? McCann: First of all, let me say that I like to support the patient’s/caregiver’s guidance as to who and how they want to see people as they get closer to death. If the patient wants it, then good. If the patient does not want it, it is still good. If the patient wants or needs to work through some relation- ships with certain family members or oth- ers, seeing and talking with them may be beneficial; and I would support and assist as much as possible. But I would not sup- port any forced interaction if the patient is able to voice their own wishes. That is not to say that the hospice team will not still be available to the entire family/friends of the patient. We can still offer support to estranged family members with the patient’s consent. Valteau-Sorapuru: It is helpful for the patient to be able to say their goodbyes to estranged family members if they have expressed an interest in doing so at any point during their illness. However, if a patient’s death is imminent and they are having anxiety about the dying process, it is usually not a good idea to force end-of-life goodbyes as it may exacerbate a patient’s anxiety surrounding death. Has the pandemic had an ef- fect on how hospice is delivered (e.g., nursing home lockdowns, challenges with PPE for workers, etc.)? McCann: Yes, the pandemic has altered the way hospice is delivered. The pandemic has caused some visits to be done virtually, especially in the first fewmonths of the pan- demic, as everyone was learning more and more about the coronavirus and how it was transmitted. Initially, with the nursing home lockdowns, we were limited to only nurses being allowed in to see the patients; now, we can send in our nursing assistant also. However, we abide by their regulations and have our staff who will be seeing patients in the facility tested weekly. Additionally, we try to maintain the same nurse and the same nursing assistant as much as possible. We were very challenged initially in obtain- ing proper PPE, as were most hospices and facilities. However, our administrator, along with donations by a couple of doctors, was able to obtain the PPE that we needed, and we have been able to continue to see our patients in person. We ensure that our staff have all the PPE they need for every patient visit. This includes all staff and volunteers. Valteau-Sorapuru: The pandemic has abso- lutely had an effect on how hospice services are delivered to patients. As a social worker, I am not allowed into nursing homes, assis- tant living facilities or group homes at this time due to health risks. As a hospice social worker, I traditionally play a variety of roles when visiting someone at a facility. I often feed patients who have a tray in front of them if they are unable to open their drink or unwrap their silverware. That sort of human contact is missing because of the pandemic. Home patients are weary about allowing visitors into their homes due to the risk of COVID exposure. At this time, I provide counseling via phone calls with my patients and/or their caregivers. Video calls are also available to patients who prefer that alternative. Is burnout in hospice workers higher than other fields of health- care? How do you help with staff burnout? McCann: Burnout can be higher among hospice workers. Primary reasons for clin- ical staff leaving hospice is often dependent upon the ability of the clinician to establish boundaries and the level of support given by the hospice agency. We encourage our staff to communicate with management when they are having a difficult time. We alternate on-call and encourage time off. We don’t allow staff to give out their personal phone numbers to patients/families. We meet weekly to discuss patients, pray and allow staff to discuss difficulties they are experi- encing. We encourage them to talk to one another and have an open-door policy with management. We are more likely to hand out a day off, a spa certificate or a hug than a censure when we see a clinician appearing to be tired, sad or just not themselves. Hos- pice is a team approach — not just with the patients but within the team itself. Valteau-Sorapuru: Inmy professional deal- ings with hospice nurses, I often lend a sym- pathetic ear to them when they share their challenges of being overwhelmed with car- ing for patients at the end of life with me. Since hospice nurses are often the first peo- ple patients and their respective families meet while in hospice care, nurses some- times play a sort of dual role as both a nurse and social worker. She or he has to address their patients’medical needs as well as their patients’ and their patients’ families’ emo- tional needs upon intake. Many times, fam- ily members are already exhausted by tak- ing care of a patient by the time they enter into hospice care. What type of legislation will LMH- PCO be presenting this year? McCann: LMHPCO’s goals at present are to: • Work with the Louisiana Governor and Legislature to appoint Alliance for the Advancement of End of Life Care board members to state boards and advisory committees dealing with end of life care issues. • Maintain Louisiana Facility Needs Review. • Monitor opioid regulatory changes; • Lobby state legislators and policymak- ers in Louisiana. • Track legislation affecting end-of-life care. • Increase awareness of services pro- vided by hospice and palliative care providers. • Raise funds for advocacy efforts.