When someone’s life is ending, the embrace of a loved one can make a world of difference. And while COVID-19 infection control and social distancing guidelines have impacted personal interaction, end-of life caregivers are still providing and facilitating support and comfort to patients and their families.

“We’ve seen quite a change in the dynamics.Social distancing has taken away some of the intimacy we’re used to at hospice,” Dr. Patrick Kilduff, medical director at Hospice of the Sacred Heart,based in Plains Twp., said in a phone interview Monday.

“A hospice patient is our most delicate patient in the medical world because they might be weakened from cancer or treatment in the end-stage of the disease process, and they’re highly susceptible to the negative impacts of COVID-19,” Kilduff said.

“It’s hard when someone is in the dying process because a family member or friend might want to come in to make that last visitor to spend as much time as they can, but it’s certainly not worth a hospice patient contracting COVID-19,” he said.

Laura Marion, vice president for Allied Services Hospice and Palliative Program, said some hospice processes have completely changed.

“When people are inquiring about hospice care,most of the time we would do face-to-face meetings. That was especially the case when a patient was going to transfer from critical care in a hospital to our in-patient center. Now, most conversations are done over the phone,” Marion said.

But, Marion stressed, nurses, social workers,bereavement support staff and chaplains or counselors are still seeing hospice patients in-person when possible, especially if the patient isn’t expected to have more than a few days or hours before they pass.

“They are all still making face-to-face visits where appropriate,” Marion said. “Depending on the situation, our staff may be in full (personal protective equipment), and we may require the patient and the family to be in masks if we’re visiting them at their home.”

Jonathon Budziak, a registered nurse with Allied Services, said the level of PPE used for all hospice patients and the order in which he sees them have been the biggest changes for him.

Budziak said he visits patients who tested positive for COVID-19 at the end of the day to prevent cross-contamination to non-COVID patients, unless they’re in critical condition. “Critical patients, obviously,are always seen first,” he said.

The amount of time patients can spend with family and friends is now dependent on how near they are to the end of their lives. And when family members are allowed to visit a patient with little time left at the inpatient center in Scranton, only two are allowed to enter the facility at one time, Marion noted.

Also, volunteers are no longer allowed to see hospice patients in person, but they continue to call patients, use Facetime or other video apps with them and send them cards and letters.

Kilduff said telemedicine, which is defined as a visit between a health care provider and a patient using combined audio and video, has increased with the pandemic.

It’s better than a phone call because “if they can see the face-to-face reaction of the nurse they’re used to seeing, that really means a lot to the patient. It allows for more meaningful interaction,” Kilduff said.

“If you can see the look in their eyes, their facial expression or the posture of their shoulders, it can help us gauge if we should recommend a call from the chaplain or a staff member,” he said.

And while some older patients are resistant at first to the use of the advanced technology, “once it’s accepted by the patient and family members, it’s been going very well. If they don’t have a smart phone or Internet access, we try to correct that as an organization. If that can’t happen, we’ll make home visits,” Kilduff said.

Budziak said he’s been using video conferencing to help connect patients with their family members for years, noting he set up a recent visit between a patient and the patient’s son, who lives in Florida.

“It makes them feel so much better being able to see their loved one and not just hear them. We do that a lot,” Budziak said.“And even though the patient might be out of it because they’re failing, it helps make the family feel better to see them.”

Budziak said hospice staff have always been close-knit, but he thinks working together through the pandemic, “everybody seems to have bonded together. Our motto has always been that we work together,but never more so than now.”

Marion believes the support that hospice staff Marion believes the support that hospice staff provide to each other gives them the strength they need to continue providing the support needed by patients and their families.

“We think every person should experience the same love, care and support at the end of life that they experienced at the beginning of life,” Marion said. “And the pandemic has not changed this mission for us.”