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During the 2020 COVID-19 pandemic, by the end of May, >35,000 deaths related to Covid-19 were recorded in care facilities, accounting for 42% of US deaths attributed to COVID-19. Transferring sick resident to local hospitals was often the first response to COVID-19 outbreak in long term care facilities (LTC) to reduce spread and manage symptoms.
Collaboration between hospice and LTC will reduce hospital transfer, provide goal-concordant care, treat residents in their residence, provide hospice expertise in symptom management to maximize comfort, streamline communication for family, and provide quality care without further COVID-19 spread.
LTC identified symptomatic residents with positive COVID-19 and referred to hospice if goal was comfort and prognosis was <6 months. LTC isolated all COVID-19+ residents in one unit. Providence Hospice expedited the referral process, hospice team evaluated all residents in person daily focusing on symptom management, educating LTC staff and family on infection control, and providing extra communication, psychosocial and spiritual support for residents' families.
On 3/29/2020, 35 residents out of 42 had symptomatic COVID-19 infection. 25 enrolled in hospice. None were transferred to hospital. 10 died within 2 months. By 6/12/2020, 6 out of 25 residents improved and discharged from hospice. Goals of care were documented for all 25 residents. 10 out of 10 residents who died used the hospice comfort kit prior to death. Symptom Management included oxygen, BiPAP, medications and clysis. Hospice Chaplain and Social worker made 78 Zoom visits and 248 telephone calls involving resident and their families. On 3/29/2020, 17 LTC staff were COVID-19+. With proper PPE, only 3 more LTC staff and zero hospice staff became COVID-19+.
Conclusions and Implications
Collaboration between LTC and hospice can reduce hospital transfer, COVID-19 spread, and stress on the staff and family. Simultaneously, hospice can provide quality symptom management in resident’s own living environment until either end of life or recovery.