Joseph Shega, M.D.

COVID-19 restrictions pose significant challenges for end-of-life care delivery. Joseph Shega, M.D., senior-VP and chief medical officer of hospice provider VITAS Healthcare, recently shared with McKnight’s how his company’s “mobile-first” platform has allowed its clinical staff to maintain a healthy distance and adhere to infection control protocol, without sacrificing continuity and compassionate care.

Q: How has the pandemic affected your hospice care delivery in eldercare facilities? 

A: Once the nationwide quarantines, visitation restrictions, and physical distancing measures were implemented in early 2020, VITAS patients benefited from our mobile-first platform and its ability to shift some of our care to virtual and telehealth platforms for patient care and visits. 

Each member of our interdisciplinary hospice team — physician, nurse, aide, social worker, and chaplain — can conduct visits through video conferencing mobile apps on their VITAS-issued phone or tablet. For concerned family members of facility residents and patients, telehealth visits and calls maintain connections between patients and families, between a facility’s staff and the VITAS team members, and between facility physicians and VITAS clinicians. This ensures continuity of care for patients. 

Q: What have been your biggest adjustments?

A: Most importantly, we’ve leveraged our mobile-first healthcare platform across the enterprise. Via telehealth, we assess and admit patients to hospice care, and we educate caregivers and facility staff. We consult by phone or video platform with physicians about hospice eligibility and the value of hospice care for patients with advanced illness, and we now provide grief and bereavement support via Zoom and phone to grieving family members and to our healthcare colleagues who remain on COVID-19’s front lines. VITAS now offers eight virtual caregiver support groups and 30 bereavement support groups, in English and Spanish, for general grief and for specific audiences.

We’ve also modified our approach to face-to-face patient visits to abide by new safety guidelines while respecting the personal and often intimate connections involved in end-of-life care. Within Centers for Disease Control and Prevention guidelines and following personal protective equipment protocols, our care team members conduct limited-but-direct patient assessments and symptoms checks within the six-foot distance guideline for no more than 15 minutes. Evaluations and visits can continue outside the six-foot distance for longer times to address important questions, update individualized care plans, and manage other topics that arise in end-of-life care.

Q: How has COVID-19-era changed your protocol?

A: We’ve rapidly instituted a protocol to secure, track, and project PPE equipment supplies for our care team members, an initiative that was supported by extensive staff education on PPE use. Simultaneously, all clinical staff completed education on hand hygiene, physical distancing, and stay-at-home policies for illness, and we mandate self-monitoring of temperature and symptoms daily through a proprietary mobile app.

We have also developed and implemented new employee operating procedures, including designation of an infection-control site manager at each of our programs to identify and manage potential or actual COVID-19 exposures.

Since the pandemic began, all VITAS policies, training, and procedures have incorporated CDC, state, and local health department recommendations governing the delivery of care to our patients by our hospice teams.

Q: Are there more changes in the works?

A: We’re now creating full- or half-day schedules weekly for our physicians and nurse practitioners to do telehealth visits with patients and their families, thanks to the involvement of the VITAS innovation team and the scalability of our mobile-first platform. This capability expands the support our physicians and nurse practitioners can provide in this time of heightened need.  

Additionally, our digital marketing, admissions, medical, and market development teams collaborated early on to update website content, printed resources, and background materials to engage our referral sources and partners, answering their questions and helping them understand how we can continue to deliver hospice care safely and effectively during a pandemic.

Q: What lessons have you learned along the way?

A: The main lesson is that talking honestly with patients and families about the care they want — and do not want — as they approach the end of life is always important, whether there’s a pandemic or not.

When we hear patients and families say, “we wish we had known about hospice sooner,” we know that we need to continue educating our colleagues about how to have difficult conversations, identify patients’ values and preferences for end-of-life care, and refer them to hospice and palliative care providers who can honor those goals with expertise and compassion. Talking honestly about end-of-life care is an important, compassionate skill that we can teach and offer to our non-hospice colleagues, because it’s a skill that we use every single day.

Joe Shega, M.D., is senior vice president and chief medical officer for VITAS Healthcare.