Anna Robson

Dr. Lapeyre

NRS 348

5 December 2020

End of Life Activity- Prompt 2

COVID-19 has led to many unpredictable, everchanging adjustments for the world.

Every aspect of life has been shifted in some way, creating constant chaos, trauma, and mental

health issues for the population as a whole. There was no way to prepare for the amount of

adjusting and learning of new norms that has occurred since the start of the COVID-19

pandemic. One aspect of the healthcare field that has been massively impacted is end of life care,

like hospice and palliative care. The purpose of both hospice and palliative care is to help

someone with terminal illness to live as well as possible for as long as possible, with

professionals who address the physical, psychosocial and spiritual distress that both the person

dying and their family are experiencing. Since the COVID-19 pandemic, “hospice centers are

faced with the task of keeping patients and employees safe, while often juggling too little

personal protective equipment (PPE) and working within the confines of their state rules”

(McCarthy, 2020). It has been a difficult situation across the board, specifically for the patients,

who are experiencing loneliness and an impersonal feel, and for the providers, because there is a

lack of advanced care planning within families.

Patients in hospice institutions are declining more rapidly because of the lack of personal

connection and the lack of physical supplies that are necessary for them to live well in their last

days. Families are seeing their loved ones’ physical conditions regress considerably more during

the quarantine period. There are many restrictions placed on visitation of loved ones in hospice
and how close one is allowed to be when they do visit. These restrictions create an extremely

impersonal feel during the visit, leading to feelings of isolation for the patient, who is in his or

her last days. This is taking even more of a toll on patients specifically with dementia because

physical touch often sparks memories for them (McCarthy, 2020). Hospice care facilities have

been attempting to troubleshoot this issue with tools like facetime, zoom call, and other

technological methods; it isn’t the same connection as in person, but it is seeming to help create a

kind of connection that is the most fitting for our current global state. Another decline seen in

hospice care is in physical supplies, like personal protective equipment, medicine, staffing, beds,

and medical equipment. This issue leads to unnecessary pain and suffering for patients due to

lack of common pain medications, like morphine, and concern from their families. Overall, due

to understaffing and wanting to keep exposure minimal, patients are experiencing less focused

care, leading some people to believe that there is neglect happening. Many adjustments are

needed to improve these issues and help to create calm and peaceful final moments for the

patients.

Many providers are facing major issues due to the fact that most patients have not created

an advanced care directive, so providers are forced to make the decisions or burden family

members with major decisions when no member of the family is certain of the dying wishes of

their loved one. During the COVID-19 pandemic, this is even more crucial. It is difficult to talk

about your own death with your family and plan that, however it is an important task because of

what it leads to later, when those circumstances arise. One must communicate what their goals,

values, and preferences would be in a treatment like palliative care (Abbot, Johnson, et Wynia,

2020). It helps to identify what the patient prefers in terms of drugs, which then in turn helps
with resource allocation during a time when resources are scarce. Nationally, advanced care

planning has become much more of a focus since the pandemic of COVID-19.

The current pandemic has created a rare set of circumstances that nobody could have

accurately prepared for, and its impact on end of life care has been substantial. The physical

aspects of hospice care are completely removed, leading to feelings of loneliness and isolation in

the patients due to the lack of visitation from family and the shock of seeing them in personal

protective equipment. Patients are also experiencing lesser quality treatment because of the lack

of supplies, staffing, and medication in hospice centers. This creates difficulty with drug

allocation and, with lack of advanced directives, many doctors are left with complex decisions

about who to give scarce resources to. Overall, more preparation is needed in the world for us to

be equipped to experience a pandemic like COVID-19. It is difficult to plan for the worst, but in

this case, with more planning, end of life care would be a place where the patients’ lives end

well.
 References

Abbot, J., Johnson, D., Wynia, M. (2020, September 21). Ensuring Adequate Palliative and

Hospice Care During COVID-19 Surges. Jama Network. https://jamanetwork.com/jour

nals/jama/fullarticle/2771025

McCarthy, M. (2020, October 1). No Hugs: How the COVID-19 Pandemic Has Impacts

Palliative Hospice Care. Healthline. https://www.healthline.com/health-news/no-hugs-how-the-

covid-19-pandemic-has-impacted-palliative-hospice-care