By Marian Grant
Those living with serious illness — a life-threatening or life-limiting illness, such as metastatic cancer, dementia, or heart failure — are at higher risk for complications from COVID-19.
Their increased vulnerability has posed additional challenges for the health workers who care for them.
Hospital staff had to get used to seeing significantly more seriously ill patients and faced significantly higher patient mortality than usual. Caring for dying patients isn’t unusual but it was previously rare to lose multiple patients each day or week. While there was community support for hospital workers early on in the pandemic, this waned later. And a contingent of the public has consistently refused to wear masks and even called COVID-19 a hoax. This has caused frustration and anger.
Many clinicians have worked extra shifts, handled higher patient loads, and covered for sick colleagues without acknowledgment or support. This has resulted in exhaustion, compassion fatigue, and burnout. Some have begun exploring unionizing as a result.
Staff in long-term care facilities, which often have a high proportion of seriously ill individuals, still lack adequate PPE and testing, and have higher levels of vaccine hesitancy. Most are poorly paid, lack paid sick leave, are from underserved communities and so often have multiple jobs and live with their extended families. They and their families got sick at higher rates, which has exacerbated the already poor staffing, and likely poor care, in these facilities. Those remaining are personally grieving the deaths of residents they may have known for years.
Home health services and hospice — both critical resources for seriously ill patients — were also low on the priority list for testing and PPE. Patients and families often rejected their services due to fears of COVID-19 contagion. This left this workforce feeling undervalued and underappreciated.
Families haven’t been able to visit their loved ones in health facilities for safety reasons. Bad news and difficult decisions have to instead be discussed via Zoom or the phone. This has amplified the suffering clinicians have witnessed. Moreover, clinicians have had to offer difficult choices to families, such as the decision between choosing to continue aggressive treatment or stopping it so as to allow for an end-of-life visitation (which some facilities allow as exception to visitation restrictions). This has caused moral distress.
Generally, the lack of a comprehensive national plan to address the pandemic has led to inefficiencies and inconsistencies in care nationwide, and endangerment of health care staff and their families. This has contributed to a feeling of hopelessness and, for some, despair.
With the new Biden Administration and the hope of broad vaccine distribution, some of these issues are being addressed. For example, the Biden administration has prioritized enacting a comprehensive national plan to counter the pandemic. And since last spring, we have learned more about the virus and developed evidence-based practices to reduce COVID-19 mortality and morbidity. Deaths have been significantly reduced since last spring. These advances help not only patients, but also clinicians, who face lessened burdens.
But the trauma of what has occurred will take a long time to heal, if it ever does. In addition, new virus variants pose concerns, and there is now a growing subgroup of patients who have long-term physical consequences from COVID-19. Worn out clinicians are changing specialties, retiring early, or quitting.
The following policy changes could help to address the suffering this workforce has experienced and possibly facilitate their continued care for people with serious illness:
- Support for the long-term care workforce – The Biden Administration announced plans to address some of the issues with the long-term care workforce and future policy needs to fix financing for this type of care. We need to increase support for a living wage, paid sick leave, and better training and career options for this important workforce.
- Visitation restrictions could hopefully be reduced with more testing, PPE, and vaccines. Although the government is not ready yet to reduce these restrictions, all hope that will happen soon.
- Mental health services/Emotional PPE – There is widespread recognition of the need for mental health services for clinicians, but there is also stigma in that workforce toward such treatment, as some worry their careers may be jeopardized by receiving it. We should work to facilitate access to psychological or emotional PPE and lessen stigma.
- Bereavement – The Biden Administration’s recognition of the 500,000 deaths was helpful, but there is the need for ongoing recognition of our national loss and grief. Half of a million individuals have died from COVID-19. That means several million families, clinicians, and communities have experienced a loss. The hospice community has long provided bereavement services, but such services need to be significantly expanded to meet current and future bereavement needs.
This suffering that clinicians have experienced, especially for those in the hardest-hit group — health care providers for people with serious illness — must be addressed, or they will not be able to provide appropriate care for the growing population of seriously ill individuals in the future.
Dr. Marian Grant is the Senior Regulatory Advisor for the Coalition to Transform Advanced Care (C-TAC), a policy consultant for the Center to Advance Palliative Care (CAPC) and maintains a clinical practice as a palliative care nurse practitioner at the University of Maryland Medical Center.
This post is part of our digital symposium, In Their Own Words: COVID-19 and the Future of the Health Care Workforce.