Hospice Providers Question Restrictions of “Social Distancing” During End-of-Life Care

Since Monday, March 9, visitors to nursing homes, rehabilitation centers and hospice care facilities have faced restrictions put in place to slow the spread of coronavirus to the most vulnerable populations.

For individuals within these facilities and their families, these new restrictions have added to the hardships endured at the end of life. 

“The way to stop a virus is to separate everybody,” said Dr. Balu Natarajan, the chief medical officer for Seasons Hospice. “But, hospice patients need to be able to be with their loved ones and they need to be with them. Social isolation is one thing, but someone dying needs to be with their family, this is way beyond a social interaction.”

“People do the best they can with the information they have, but basically they go into modes of restriction in an attempt to stem the tide and are encouraging social distancing to flatten the curve,” Natarajan said. “That is fine, but what needs to change is the approach when the stakes of social distancing are higher.”

Seasons Hospice serves patients at two Connecticut-based facilities in Bloomfield and Middlebury, as well as others across twenty states.

“In cases when someone is dying, the last goodbye or opportunity to say I love you and I’m sorry is actually part of the care plan,” Natarajan said. “Social distancing is not really applicable.”

Natarajan said that he has reached out to the Center for Medicaid and Medicare Services for guidance as Seasons Hospice faces restrictions on allowing family members and even professional healthcare staff to visit and attend to those in their care.

“The guidance from CMS is explicit in making sure that people in hospice are protected from this virus and that includes limiting visitors, but they make some reference to the importance of following plans of care which include social interaction and bringing families together,” Natarajan said. “We are able to use that language to be able to explain that a person’s dying process and the healing process for people around them is incredibly important.”

In cases where facilities are not able to allow even end-of-life visitors, Seasons Hospice and the National Association of Hospice and Palliative Care are making efforts to provide for virtual visits with the aid of Skype, Facetime and What’s App.

Unlike in previous infectious disease outbreaks, Natarajan said that information and changing directives have spread faster than the virus itself, sometimes making the response seem more extreme.

“People do the best they can with the information they have, but basically they go into modes of restriction in an attempt to stem the tide and are encouraging social distancing to flatten the curve,” Natarajan said. “That is fine, but what needs to change is the approach when the stakes of social distancing are higher.”

Seasons Hospice said they are available to advocate for anyone whose family is experiencing hardship and separation while in hospice during this time.