In the midst of this respiratory pandemic, Our Hospice of South Central Indiana recently provided information to our community on a temporary process to help contain the spread of the disease, by limiting visitors. We want to share facts of how our care is delivered to families at end of life, and to create understanding of the reasons this decision was made.

Our presence in the community dates back to 1979 when a small group of community members dedicated time and funds to start end-of-life care in the tradition of Hospice Care. Now as it was then, as a not-for-profit organization, we believe that every person that faces an incurable disease and accepts an illness as a terminal condition deserves competent and professional symptom control and comfort care. At this time, this includes hospice eligible patients who are COVID-19 positive, and it is no different than when we have cared for patients with tuberculosis, HIV/AIDS or other contagious diseases. We play an important role in the continuum of care and will continue to take care of all seeking our help at the end of life.

Hospice care is provided where the patient resides, which can be their home or a residential/extended care facility. Our home service area includes 16 counties where we currently serve 240 patients. Our hospice center located within the CRH campus is not a residential facility. Only a small number of patients receive care there temporarily, either to give family members respite if patients reside at home; or for an acute episode of unrelieved symptoms that cannot be managed in the home, which sometimes results in the patient dying in our facility, although most of our patients pass away at home.

To minimize risk and exposure to patients who may need to be here during the respiratory epidemic, we have identified one of our Hospice Center wings to exclusively care for COVID-19 patients. This is where we are caring for current hospice home patients that have tested positive for the virus, or for patients that have contracted the virus and elect to be cared for by hospice because they are not expected to survive the infection. With carefully planned and executed precautions, specially trained staff is assigned to care for the patients in the identified wing. These employees are required to wear additional protective equipment (N 95 masks which are individually “fit-tested” for each employee, gowns, goggles and gloves or PAPRs, which are motor-ventilated sealed hoods). These caregivers are also required to take additional precautions for decontamination after exiting patient rooms. We have private rooms for all patients and they do not come into contact with one another.

The no visitor policy is designed to protect our patients and staff. Hospice patients are some of the most vulnerable should they be infected by COVID-19. According to the Cleveland Clinic, up to 80% of the population who is infected will have mild to no symptoms, meaning they are contagious but may not know it. The Indiana State Department of Health reports that people are often most contagious prior to developing symptoms. Allowing visitors into the center at this time poses an unnecessary risk to these vulnerable patients as well as our staff to care for them.

Hospice was founded on the belief of providing comfort at the end of life and our goal always is to have no patient die alone. During this epidemic, our clinical staff is working diligently to anticipate care needs for our 240 current patients, to keep them in their residence and avoid having to come into the hospice center; and we work with each family/patient situation for those who need to be in our hospice center. For patients who are not positive for COVID-19, we do our best to allow end of life visits for limited family members. We reduce their risk by having them enter through our patio doors, wear a mask and return home promptly. For COVID-19 positive patients it is totally different, as additional personal protective equipment, specifically a PAPR,  is needed. We will work with those families on a case-by-case basis. Preventing community spread from individuals having been in our building, without adequate protection, is a responsibility that our medical staff and leadership consider imperative.

As end of life is an important time for family and friends, our building and our visitation policy have always been very open, we regularly have many friends and family members in and out. At this time, when it is difficult to know who is contagious and who is not, it is our social responsibility to temporarily stop general visitation. We need to do everything we can to protect our patients and our staff so we have the ability to care for everyone who needs us as the epidemic continues. COVID-19 is a contagious, airborne respiratory disease, and limiting the general public in our facility is the prudent thing to do.

Our commitment to end of life care and our mission To Make Every Moment Count, guides us to ensure we are here for our patients and that no one dies alone. Please be assured that no family visitors have been denied an end of life presence up to this point, and we will continue to work to fulfill our mission while protecting patients, visitors, staff and our community.