Mary Ann Evans Hospice – How it has been …
March of this year Covid-19 hit the UK, this was a difficult and anxious time for the country as there were so many unknowns about this virus. Mary Ann made the decision that our services would need to change, this decision was not made lightly but the patients we see on a daily basis have some very high risk factors.
We, as a staff group, had to contact all of the patients on the caseloads from the Lymphoedema clinic and Day Hospice and inform them that the services had to be changed due to Covid-19. We had to tell them that unfortunately they would not be able to attend the Hospice. For some patients this caused great distress as visiting Mary Ann was their only time that they left their homes, they looked forward to having contact with us, we had built up great relationships with them. Although the patients would not be able to come into the building we, as a staff group felt strongly that we needed to keep in touch with everyone so we started making weekly phone calls to each patient. Hours have been spent each week making phone calls, checking on the health and wellbeing of each patient, signposting to other services if needed and giving lots of reassurance about the current pandemic.
Staff from both of these services were quickly trained and up-skilled to enable them to work effectively within our Community Services Team and be integrated into this team.
Patients on the Hospice at Home caseload had to be contacted and informed that the team would not be able to provide much needed respite during both the day and night. Also the regular support visits where families had time to talk about their concerns and how they felt things were changing, this is where we could gently explain that the changes were normal for people entering their end of life. We would talk to them and by the end of the visit they would feel calmer and more able to cope with things. This was very difficult for both staff and patients to come to terms with. We continued to offer telephone support to each of these families however nothing could replace the respite visits which allowed the families and carers to get some much needed sleep and rest.
Hospice at Home is a very different service from the Day Hospice, which was the service I (Hannah) was used to working in. We were now on the front line, supporting patients at the very end of their lives, as well as giving emotional support to their families and loved ones during their hardest days. As you can imagine this is a very challenging job, both emotionally and physically, during normal circumstances however, Covid-19 has made this much more difficult. Families are worried about having different people come in and out of the house, they are anxious about the virus being brought into their home.
When we attend someone’s house we are wearing full PPE this involves wearing; a surgical mask, a visor, an apron and gloves. Some families found this frightening and a lot of reassurance was given to them to ensure this was the safest practice.
PPE is essential to our safety however it causes a barrier as we support people in the very last days of their lives. We often have to have difficult conversations about death and dying which is made more difficult by the barrier created by the PPE. As I am sure you are aware the majority of our communication is non-verbal which is then lost when your face is covered by a mask. Patients and their families are no longer able to read our faces or see the empathy in our eyes. We have to speak louder so that we can be heard which means that the empathy in our voices gets lost. Due to the 2 metre social distancing rule we are no longer able to comfort the families in the way we would like to, we are no long able to hold their hand or give them a reassuring hug when they need it most.
Although we speak to our patients and their families before each visit, asking if they have developed any new symptoms, when we arrive at their home there remains an anxiety for the family and staff as people can often have the virus without any obvious symptoms. There is always an element of the unknown when we are standing at the door to a house.
There is still a worry that someone in the house could have Covid-19 and not be showing any symptoms. There is still a worry for our health, the health of our colleagues and our families.
At the end of a long, hard day we return home to our families but before we are able to say hello or have a cuddle from our children we have to ensure we have de-contaminated ourselves to protect them. Our children worry about us going into work, they cry when we leave in the morning as they are scared from what they are seeing on the news. Our personal relationships become harder as our partners worry about our health but also worry about what we might be bringing back into our own homes. We worry because we may be the only one supporting elderly parents, they worry because they know the work we are doing and how important it is, but they are concerned for our health if we are assisting patients that may have COVID symptoms.
All in all it has been a difficult three months, some staff have been working extra hours and have been working throughout this time; some staff have been furloughed, due to cutting down on the numbers of staff that it was safe to have in the building because of distancing; some have been working from home which I am sure has at times been a very lonely time; some have been off sick due to their own health problems or because of their age and the need to follow government guidelines. We are used to speaking with each other about our different patients and this has been difficult to do – we are used to all being together.
Family Support and Bereavement Services team began working from home once Covid-19 hit and very quickly changed all of their support from face to face support to telephone support. A whole new way of working was set up in 48 hours and no single person missed their session or had support cancelled. Providing telephone bereavement support is difficult for the team because it isn’t the normal or ideal way of working and a lot of warmth and empathy can be missed when working with bereaved people who can’t see your facial expressions or body language. All group work had to be suspended due to social distancing and telephone support was offered individually to each group member. Some clients found that telephone support did not suit them and instead chose to maintain support from us as and when they needed it. On the other hand, some clients relished the anonymity and time efficiency that telephone support brings. All work with younger children had to be suspended and instead of supporting the child directly the team moved to supporting their parents via regular phone support calls. New clients entering the service have had their bereavements complicated by the consequences of COVID -19 restrictions; not being able to visit their loved one when they are dying, having limited numbers at the funeral etc. What was already a very difficult time for families has become even more complex and, as a result, the support the team offers to these families is more in depth.
The Family Support and Bereavement Services team itself went through some changes as two new members of staff joined the team just as lockdown hit. As you can imagine this made an already stressful time much harder, they joined the Mary Ann Evans team and have not been able to work in the office or meet the wider team. However, the team have all pulled together and are keeping Team MAE alive virtually with regular Zoom team meetings.
Mary Ann Evans had a large volunteer work force who work in all different areas of the Hospice including day hospice, family support services and the shops. We have had many volunteers help us in making phone calls to patients on a regular basis or make quizzes for our new patient newsletter which has been sent out to Day Hospice patients. However, there have been many volunteers who continue to greatly missing the Hospice.
Although we only had the clinical team in the building for many weeks there were still lots of jobs that needed to be done around the hospice i.e. fundraising, housekeeping etc. As a clinical team we started a fundraising complain called “Sponsor a Nurse” which allowed the public to sponsor a member of staff for up to £100 at a time. This was a tremendous success and to date we have raised over £20,000 through this campaign. We also continued to receive phone calls from local shops who have our tins for donations, our clinical team would then organise for these to be collected in between their visits to patients.
On a day to day basis you would often see our CEO or other members of the management team cleaning, hovering and generally keeping the hospice tidy. Our Rapid Response night’s team would also often help with the housekeeping of the hospice through the night.
Despite how difficult this time has been we have been greatly supported by local people and businesses who have been so kind and donated lots of snacks, drinks, toiletries and PPE to the team – thank you to you all that have helped in whatever way, it really has meant a lot to us all.
We have all tried to keep in regular contact with each other, and ensure that we maintain our team spirit, we know that some of this way of working will be ongoing and that the services may have to change a lot and new services will have to be introduced, but through it all we are TEAM MARY ANN and we are proud.
On behalf of everyone at the Mary Ann Evans Hospice:
Hannah Richards – Day Services Team Lead
Tracey McGhee – Senior Care Support Worker
Laura Hankey – Bereavement & FSS Lead