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Hospitals are experiencing huge resurgences of virus-related admissions, emergency departments are over capacity, and many facilities are again under heavy restrictions. Now is the time to ask yourself: Is my hospice agency ready to face the challenges of the season?

The winter season has settled in, and the third year of the coronavirus pandemic is approaching as well. Clearly, life is not yet “back to normal.”

However, we have found a new normal in healthcare, with the continued use of masks and other protective equipment becoming second nature, along with the quiet frustration of pandemic realities. Everyone still has their breath held, their masks on, and their anxiety levels peaked now that coronavirus variants are in the wintry mix.

To add to the tension, the season’s old friend, influenza, is also making an appearance and adding further complications. Hospitals are experiencing huge resurgences of virus-related admissions, emergency departments are over capacity, and many facilities are again under heavy restrictions.

Now is the time to ask yourself: Is my hospice agency ready to face the challenges of the season?

A Frustrated Nurse and a Tense Manager

Jane, a nurse whom I supervised, had practiced in hospice for five years; the management team believed she was well-equipped to deal with the ongoing pandemic and onslaught of influenza. Jane took great care with patients and families and was well liked.

One of her patients, Mrs. Perry, had been diagnosed with end-stage Parkinson’s Disease and lived at home with her daughter. One day, during an interdisciplinary team meeting, Jane gave report on Mrs. Perry and advised that team that Mrs. Perry’s daughter had COVID and requested telephone visits for the next few weeks. The daughter didn’t want to isolate herself from her mother, since she served as her primary caregiver. Jane told the team, “I told her it was fine because she is in a tough spot, and to wear a mask when she gives care. Not much we can do.”

I recall being stunned by Jane’s words and her dismissal of the issue. I told her that we must try harder; that there was more we could do for Mrs. Perry. Jane was frustrated and we had a conversation, as a team, about the fatigue felt concerning yet another round of spreading viruses. The entire staff present agreed that the strain of the season was wearing on them, and they felt less motivated to deliver quality care sometimes.

Jane and my other employees were frustrated, and as their supervisor, I was tense. How could we just accept a request for telephone visits and not remind this patient’s daughter of what we were capable of? We had been operating in virus-riddled environments for months, and I had trained every staff member to use their equipment and knowledge effectively.

Are we not giving the best care that we possibly can to our patients and their caregivers? Have I failed to prepare my staff to make the best decisions for their patients?

Delivering Quality Care and Refusing to Give Up

Mrs. Perry had no fear of the virus; she frequently asked members of my staff if they would remove their “alien outfits” so she could see their faces. Of course, they kept their PPE in place. Visitations from Jane and the aide were increased in lieu of the requested telephone visits, and Mrs. Perry was carefully monitored for symptoms of the virus. Despite our best efforts, Mrs. Perry still contracted the coronavirus.

Jane taught Mrs. Perry’s daughter how to give nebulizer treatments for the congestion that Mrs. Perry developed and provided ongoing education on how to manage her symptoms. Despite excellent care, Mrs. Perry declined, whether related to her Parkinson’s disease, the virus, or both, and would never recover. Within a few weeks, she passed away.

After that conversation, Jane and the entire team never gave up. They put aside their frustration in the season of spreading viruses and provided amazing care. It paid off; when her mother passed away, Mrs. Perry’s daughter told Jane, “I am so thankful for hospice.”

A Gentle Nudge to Accept the New Normal

The seasonal waves of the coronavirus and influenza are not going to stop. They are part of our new normal. We must not allow ourselves to become frustrated and let it affect the quality of care provided to patients and families.

In 2022, when CAHPS surveys and star ratings are weighing heavier in the minds of hospice agency administrators, quality counts now more than ever. Telephone visits are easier, staffing may be at a minimum, and employees are still fighting the fatigue and pressure that they have faced in the pandemic.

Mrs. Perry’s daughter was trying to be helpful and avoid having the team enter her home, but the team knew how to use their PPE and function well to deliver great care. Even though I had to remind Jane to not take the “easy way out” and simply accept the requested telephone visits, she gave great quality care to her patient.

Jane later told me, “I just get tired of hearing about all of these viruses.” Everyone has felt like Jane did, no matter the role you play in your agency. Sure, it would have been easier to allow for telephone visits. It would have been easier to save the team’s resources and simply avoid the household. The team was tired of restrictions across the territory and tired of hearing the words “COVID-positive.”

Jane’s first instinct was to become frustrated, because she is human. The pandemic is still further complicating an already difficult industry. Healthcare providers are still exhausted. A good agency, however, does not give up trying. A little nudge, a gentle reinforcement of “Hey, I know you can do better” is sometimes needed for everyone.

Empower Your Team to Give Quality Care in This Challenging Season

In this season of uncertainty, take a deep breath, encourage your staff with gentle nudges as needed, and create a plan to maintain your quality of care during these difficult months:


  • Teach your team to recognize early virus symptoms and seek treatment orders as soon as possible. Adjust your hospice care plans frequently to adapt to the needs of the patient.

  • Consider protocols specifically for COVID and flu positive patients within your agency, including contingency plans for increased visitations from staff and special medical equipment ready for urgent order (nebulizers, oxygen, and specified medication regimes for acute symptom management). In this wave of the pandemic, resources are more readily available, so utilize them. 

  • Provide education to caregivers. The CAHPS survey asks repeatedly for caregivers to rate how education was provided on various topics. Train caregivers on symptom management and reinforce the education repeatedly. Make a handout; print out CDC resources; create something tangible to “show” your team’s efforts. Ask your team to help create resources.  Have clinicians use simple methods, such as asking patients and caregivers, “Can you repeat back what I just taught you?” Don’t wait to educate either! Talk about COVID variants and influenza before families are exposed and encourage ongoing preventative strategies. 

  • Talk to your staff about what is happening in your community. Monitor the local positivity rates and hospital admissions and share the numbers with your staff. Celebrate decreasing numbers to focus on the positive too.  

  • Reinforce staff appreciation. Acknowledge the difficult winter season and the persisting fear of the unknown. Your agency’s employees need to know they are valued. Schedule a meeting just to say, thank you. As an administrator, I paid for a pizza dinner to be delivered to every clinician on a random Friday evening with a simple accompanying text message that read, “Don’t make dinner tonight, hospice is treating you and your family because you have done an amazing job. Enjoy some pizza.” Buy blank thank you cards and encourage staff to complement each other, then read them during team meetings.


Most importantly, define the quality of care that you want your staff to deliver to patients and families. Discuss successful management strategies for all patients. Don’t assume clinicians, like Jane, are grasping what needs to be accomplished. Monitor the goals in care plans carefully. Make your interdisciplinary team meetings a more thoughtful examination of how your agency can “try harder” for every patient. If you receive positive feedback from caregivers, referral partners, or within CAHPS surveys, share them as examples of how to provide quality care.

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