During a pandemic, being able to provide hospice care to terminally ill patients is more important than ever — and more of a challenge than ever.

When the mission revolves around providing compassionate end-of-life support for patients and their families, how is hospice care safely served to the most vulnerable segment of the community? That’s an equation the administration and staff of Hospice of the Foothills have been working out since COVID-19, even before the state-mandated shutdown orders.

For more than 40 years, Hospice of the Foothills has been serving approximately 500 patients and families annually in western Nevada County and eastern Placer County, with a typical care plan including pain and symptom management, personal care, social services, spiritual support, respite care, grief support and bereavement services.

“Things have changed,” Executive Director Vivian Tipton said, citing an increased reliance on telemedicine as just one example of her nonprofit agency’s shift during the pandemic.

“We found families were asking us not to come into the home,” Tipton said. “We work with definitely the most vulnerable people in the community, and we have adapted to that. We do see patients face to face unless they ask us not to. In that case, we do audio calls, we’ll meet in parking lots and holler. … It’s a very unique time in health care.”

Keeping connected

While working with patients has become more challenging for hospice staff, the experience has been nothing but positive for Coy Cross, who was diagnosed with pancreatic cancer last fall and who has been provided hospice care for about a month.

Cross made the decision earlier this year not to go through chemotherapy or radiation treatment.

“I’m 82 years old,” he said. “It did not make sense to me.”

Past experiences with friends and family members entering hospice care in Sacramento had not been that good, Cross said, adding, “I had some hesitation.”

But as time went on, his energy level dipped and he realized, “It was time.”

Despite his reservations, he agreed to meet with several hospice organizations. His decision was quickly made when he met with a representative from Hospice of the Foothills, Cross said.

“She was wonderful,” he said. “It was obvious she was very connected to the community and even more obviously, connected to me.”

In the time Cross has been in hospice care, he said, everyone he has dealt with has been personable and professional.

Cross is receiving in-person visits — with everyone coming in to his residence wearing a mask — and conducting video calls with a home health nurse, talking for about 30 to 45 minutes a couple of times a week.

“It’s fine; it’s not foreign to me,” he said. “It’s much easier, doing calls one on one, frankly.”

National trends

Tipton estimated about 60-70% of the agency’s current patients are opting for remote visits.

“We always keep what the family wants in front of us,” Tipton said. “That’s the beauty of hospice work. What they feel and need is always the most important thing.”

Hospice of the Foothills has not had any families with COVID-19 cases, she said, but added the organization is prepared for them.

“We have the proper PPE (Personal Protective Equipment),” Tipton said. “As an agency, we met and discussed our mission, how are we going to meet that mission. Luckily for us, in our community, (COVID-19) been slow to progress. We had the time to prepare ourselves, we have kits made up. If a nurse is going out to a home where a patient has or is suspected of having the disease, we are able to outfit them so they can treat them safely.”

According to Tipton, Nevada County has seen a drop in admissions consistent with nationwide trends.

“Our numbers have dropped,” she said. “Currently, we have 68 patients, when typically we have 75-80.”

For one, Tipton said, fewer referrals are being made by Sierra Nevada Memorial Hospital and by primary care physicians.

“Many people are not going to their physicians or the hospital, they’re staying at home,” she said. “You don’t need a doctor’s order, you can refer yourself. But that’s a very difficult call for families to make.”

Hospice of the Foothills, like other nonprofit agencies, has faced some financial challenges.

“Our thrift stores being closed has had a profound financial impact on us,” Tipton said, adding that store staff have been furloughed since March 17. But thanks to an SBA loan, managers have been brought back as of this week to help prepare stores to reopen when they can do so safely.

Hospice’s clinical staff already “flexed” off work when demand was low, Tipton said, adding that some chose to take advantage of the Families First Coronavirus Response Act funding to deal with child care issues during the shutdown.

Along with the challenges, Tipton said, is a unique opportunity for Hospice of the Foothills.

“One of the things we’re wanting to do is discussing our own mortality, bringing that conversation up to the surface,” she said. “Now is the perfect time.”

Contact reporter Liz Kellar at 530-477-4236 or by email at lizk@theunion.com.