For Katie Davis, alumna of the USC Suzanne Dworak-Peck School of Social Work, hospice care does not stop for the COVID-19 pandemic, it readjusts to the present circumstances.

In the little town of Snohomish, Washington, the antiques capital of the pacific northwest just an hour northeast of Seattle, Katie Davis, MSW ’15, is part of an interdisciplinary team working for a hospice organization.  

Each patient has a nurse, a social worker, a spiritual counselor and a health care aid, all overseen by a physician. To be admitted for hospice care, someone must have a terminal illness and, based on two physicians’ best estimates, have six months or less of life, based on natural disease progression.

Despite the COVID-19 pandemic, the hospice is still operating to full capacity, continuing to take on referrals and bring on new clients, but circumstances around care change day by day, hour by hour, which requires constant adjustments. The biggest challenge Davis now faces doing her job within this environment is the moral distress, despite the extreme support of her organization.

“So right now it’s kind of finding a balance between how to do your job effectively, how to keep your patients and families safe, how to keep your own family safe, how to keep yourself safe—there are so many complexities to that, and in doing so, we’re having to pull back,” Davis explained.

Facilities with whom they work are restricting visitors, even outside clinicians.

“Emotions and feelings come up when your work and your practice are not really aligned with the ethical practices that you would typically use for yourself to guide care,” Davis said.

Under normal circumstances, she works with hospice patients and their families to support a plan of care that is in their best interest based on their goals, values and safety, while also supporting their autonomy and independence.

Now, Davis often feels helpless. Due to some patients or their family members testing positive for COVID-19, she and other caregivers on the team have to take extra precautions while continuing to care for them. But doing visits over the phone is very different from in-person care because she cannot see people’s body language, facial expressions, living environment and there is no touch.

“So much of our role, and the spiritual counselor’s role, is trying to alleviate not necessarily the physical suffering but the emotional and spiritual suffering that comes with dying,” Davis said. “And that is a big challenge to do when you can’t be face to face with someone.”

The palliative approach

Beyond helping their own clients, her organization has partnered with local hospital staff as they care for large numbers of patients suffering with COVID-19, having the conversations with patients and families about grief. Conversely, physicians are helping with medication support due to the physical suffering that comes with COVID-19 and the respiratory challenges.

“That is the mission of a palliative approach,” Davis said. “Giving comfort, giving dignity, giving compassion and relieving suffering.”

Davis stressed that while it is such a challenging time right now, it is important for people to know that hospice care is not stopping. “I think there is a lot of fear for folks that are toward the end of their life and how can they get the resources they need if we’re all focusing on this COVID-19 situation,” Davis said.

Her organization, and she hopes other hospices, are operating from the standpoint that terminal illness in life does not stop for a pandemic.

Davis wants people to realize how much control they have over their own environment, and it is important to have conversations about what is important to loved ones in life and in death.

“It's really tragic seeing there are increasing rates of loved ones dying alone in hospitals and isolation where families can't visit,” Davis said. “That completely breaks my heart. So I think it's important to have those conversations and keep yourself safe.”

Seeing the beauty in one another

More than ever, the professionals in Davis’ group are supporting one another and that is helping. Working from home, on the phone and in the field with the new restrictions is more exhausting than is typical and enhances the risk for compassion fatigue. Caring for others, taking on the heaviness of someone else’s experience and having empathy for that person can cause a lot of burnout and the inability to cope.

“I would encourage folks to be really flexible in their work and their self-care practices,” Davis said. She normally paints, does yoga or rides her bike. Now, those things are not as effective in helping her relieve stress. It is important, she said, for people to acknowledge that what is usual for them may not work, and to try something else.

“Maybe there’s five minutes of sunshine, so I put down my paper and I run outside for two minutes!” she said.

Davis is inspired by community members coming out of the woodwork to help. She sees more people volunteering to support food banks and Meals on Wheels, older adults getting their own time to go to the grocery store and people supporting local businesses to try to keep them afloat. Davis’s partner is a high school teacher, and it encourages her to witness him getting creative to keep his students engaged and connected.

“It's a really difficult situation in more ways than just the virus of it,” Davis said. “I think that acknowledging the hope and the beauty that's still in life can really be inspiring and help relieve you a little bit… just being able to walk away from the news and see the other beauties.”