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Bringing ‘Poogie’ Home: Hospice In The Time Of COVID-19

After she landed within the hospital with a damaged hip, Parkinson’s illness and the coronavirus, 84-year-old Dorothy “Poogie” Wyatt Shields made a request of her youngsters: “Bring me home.”

Her request got here as hospital sufferers all over the world have been dying alone, separated from their family members whether or not or not that they had COVID-19, due to visitation restrictions geared toward curbing the unfold of the virus.

Bringing dwelling a terminally in poor health affected person with COVID-19 bears further challenges: In addition to the already daunting duty of managing their beloved one’s care, households should take painstaking precautions to maintain themselves secure.

Julia Shields, 53, certainly one of Poogie Shields’ 4 youngsters, mentioned she had reservations in regards to the danger of an infection and the way it would possibly have an effect on her household’s well being and talent to look after her mom. “I didn’t want to bring my mom here, and have it where we’re all of a sudden collapsed in bed ourselves and can’t give her pain medicine and can’t take care of her,” she mentioned.

But she and her siblings have been decided to honor their mom’s needs. So they stocked up on private protecting gear and transformed the mudroom of Julia’s Greenwood, Virginia, dwelling west of Charlottesville right into a solarium the place her mom could possibly be nearer to household.

Julia mentioned she wasn’t positive how lengthy her mom would survive; it may have been just a few days or perhaps a few months at her dwelling. “She’s such a fighter,” she mentioned.

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Poogie Shields, a former steering and dependancy counselor, had an urge for food for journey, be it tenting on the Appalachian Trail or transferring her household to Paris for a 12 months whereas writing a grasp’s thesis. After elevating her youngsters in Virginia, she set off to do volunteer work, serving to homeless youngsters in Florida and pregnant ladies going through dependancy in Washington, D.C.

But over the previous 20 years, Parkinson’s illness steadily restricted what she may do, and three years in the past she moved into an assisted dwelling group in Crozet, Virginia, about 5 miles from Julia’s dwelling. At first, she walked everywhere in the campus, taking yoga lessons and enjoying trivia with mates. But lately, she may handle solely brief distances with a walker, and Parkinson’s, a progressive nervous system dysfunction, was affecting her voice, in accordance with her daughter.

“She was the person who had the most interesting thing to say in the room,” Julia mentioned. “It was sad. You just couldn’t hear what she had to say.”

In mid-March, because the pandemic unfold, Shields spiked a fever and bought examined for the coronavirus. On March 22, whereas self-isolating and awaiting her check outcomes, she broke her hip and was taken to the UVA Health System University Hospital.

In the hospital, a rapid-results check got here again constructive for COVID-19.

The coronavirus wasn’t killing her: Her signs had largely subsided, and she or he wasn’t in respiratory misery, mentioned Dr. Lily Hargrove, a personal observe doctor who had handled Shields for 15 years and suggested her household.

The greatest drawback was her hip. Surgery was an possibility, however Shields had already endured “an excruciating loss of independence” over the previous two years, Hargrove mentioned. Recovery from surgical procedure — two to 3 months in a rehab heart with no guests due to efforts to gradual the virus in most services — “would have been a nightmare,” Hargrove mentioned, and wouldn’t have returned her to regular functioning. She mentioned she and Shields had reached an understanding throughout the previous 12 months that her illness had progressed to this point that “we were beyond the point of fixing things.”

Julia and her siblings consulted a palliative care specialist and determined to pursue hospice. The hospital and hospice staffs instructed the household “this was not to be taken lightly — not only her dying, her potential pain, and also us getting sick,” Julia mentioned.

The household signed up with Hospice of the Piedmont, which is certainly one of about 75 community-based, not-for-profit hospices within the National Partnership for Hospice Innovation (NPHI). Dr. Cameron Muir, NPHI’s chief innovation officer, mentioned most hospices within the group have handled or ready to deal with COVID sufferers, regardless of the added dangers for staff.

Many hospices are going through shortages in staffing and protective equipment as a result of pandemic, prompting concern from some advocates that sufferers gained’t get the care they want. Muir mentioned hospices in his group have bulk-ordered protecting tools collectively.

With the pandemic, most NPHI hospices are seeing a rise within the variety of folks they’re caring for at dwelling, Muir mentioned, as a result of hospitals are “eager to get people with advanced illness home if possible” to make room for COVID sufferers.

“Absolutely the safest place for frail elderly without COVID is in the home,” mentioned Muir, who can also be chief medical officer of Hospice of the Piedmont, and “if you’re COVID-positive, the best place to be quarantined is at home.”

Hospice of the Piedmont has shifted to telehealth when attainable and has stocked up on protecting gear in order that employees and households can safely deal with COVID sufferers, mentioned CEO Ron Cottrell.

While the hospice gathered tools, Julia and her household set to work making a sterile-yet-welcoming solarium in her dwelling. They cleared out the raincoats and lacrosse sticks from Julia’s mudroom. They rolled in a hospital mattress subsequent to a window overlooking the deck and hung an image Julia’s daughter had painted.

They stuffed the windowsill with contemporary daffodils. Julia’s husband and two youngsters, 18 and 20, went to remain at a buddy’s empty home, whereas certainly one of her sisters moved in to assist her care for his or her mom.

On March 25, Poogie Shields got here dwelling, sedated with ache remedy. Out the window, she may see a redbud tree in bloom and, quickly, the faces of her visiting grandchildren and different kin.

Julia, a tax preparer, and her sister, an archaeologist, bought right into a rhythm of suiting up like hospital workers — in scrubs, gloves, shoe covers, masks and eye safety — each time they entered the room.

Their time collectively was peaceable, Julia mentioned. Other relations frolicked on the deck, 6 toes aside, simply exterior the window. Her sister introduced an iPad to coordinate video calls and browse aloud dozens of emails and playing cards.

“There was a fairly reasonable feeling of normalcy,” Julia mentioned.

Over the course of a number of days, Poogie Shields grew to become unable to eat, drink or swallow remedy. With Hargrove’s recommendation, Julia and her sister managed her fentanyl patches and slipped morphine beneath her tongue.

As her mom started to lose consciousness, Julia softly sang Episcopal hymns — “Abide With Me,” “Breathe on Me, Breath of God” — to consolation herself and her mom, simply in case she may hear.

Poogie Shields’ final day “was very peaceful,” Julia mentioned. “It was such a beautiful day.” Relatives had all come by to see her. There was “no anxiety about anything that we needed to figure out,” no final unburdening of unresolved emotions.

Julia mentioned she and her sister have been with their mom as she took her final breath at eight:30 p.m. on March 28. Hospice employees got here to the home about three hours later. In the meantime, Julia mentioned, “nothing needed to be done. It was just very calm.”

Hargrove mentioned that in her 20 years of observe, “I’ve never had a patient die with such reported ease and grace.”

“The two daughters were extraordinarily brave,” she mentioned. “They were committed to honoring their mom’s wishes.”

After their mom’s demise, Julia and her sister disinfected the home earlier than Julia’s household moved again in. No one within the household has develop into sick with COVID-19.

For different households, bringing COVID sufferers dwelling may not be attainable, particularly if somebody in the home is at the next danger of great problems from the virus, Hargrove famous.

“I would hate to have someone who was unable to bring someone home, who was dying of COVID-19, to think that they had somehow failed that person,” Hargrove mentioned. “I would ask that people find grace and compassion for themselves if this is not available for them.”

Melissa Bailey: @mmbaily

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