 aging with grace. And my question this morning is, will hospice care on the island of Oahu be killed by the coronavirus? I've asked one of my cohorts to come on and respond to that question and more about hospice care and how it is affected by the COVID-19 virus here on Oahu. So we're going to get some really wonderful information as well as the perspective of a person who has been deeply involved in health care and and also in particularly in hospice care. Her name is Erin Hamilton and she works for Bristol Hospice. Hello. Hi Larry, thanks for having me. Welcome. So I am concerned about the elderhood because I am convinced that we don't have to age like my parents did. We don't have to get fat and decrypt it and have our elder years be miserable. In fact, with the resources and some of the people who are here on this island, we can have a wonderful experience at a rich elderhood, which I call it, for the end of up until the end of our life. And one of the issues or one of the resources that's available that I cherish myself is hospice care. And in particular, Bristol hospice. I've had the opportunity to do a hospice care in Denver, Colorado, spiritual care in the hospice care, spiritual care here with Bristol. And also to know you, Erin, as one of the wonderfully competent staff members that we have. So please introduce yourself a little bit for us. Sure. So my name is Erin Hamilton. I've been in hospice for eight, almost nine years now. Born and raised in Hawaii and I'm very happy today to be here and talk with you and kind of dive more into this. Did you grow up on the island? I did. I was born and raised on the North Shore and then I went to the University of Hawaii of Manoa. And Major Dan? I have a communications degree and business health. Wonderful. Well, so to the question, is the COVID virus going to kill hospice care on Oahu? Definitely no. So I would say that in terms of the depth, it would be really defined by what your explanation is of that. And so whether it is changing it, it's for sure changing our entire experience of hospice. It has definitely increased our variety of ways that we're visiting patients. So whether that be in person still or doing a lot, like we are now doing virtual meetings. So telehealth visits, I think our medical society has had to change completely just because of the COVID virus. It's also restricted access. I think we're much more mindful of our footprint that we're having. Thank you. Let me explain a little bit of why I requested you to come. I'm of the assumption that most people don't know much about hospice care in the first place. And the second place is that facilities that care for people in their elder years are set off the beaten path. They're not what we look into until we absolutely have to. And then it's such a strange world for families and friends to negotiate and navigate. And certainly now that there's COVID-19 concerns throughout the world and throughout the United States with regard to nursing homes, I thought we would look into that. There's been 249,000 confirmed cases of COVID-19 in nursing homes across the country. That's across the United States. There have been 50,000 confirmed deaths from COVID within nursing homes across the nation. And here we don't have quite the same dramatic numbers. But I'd like to explore a little bit about what those numbers are. But also to begin with, I'd like to imagine that you're coaching me on placing my loved one in a facility not necessarily for the COVID, but for hospice care or in a facility needing hospice care or in my home in needing hospice care. What does the impact of COVID on hospice care for those different scenarios? Sure. So typically hospice care is going to be either done in a facility setting, whether that be a skilled nursing facility setting or an inpatient setting, or in a smaller setting like a foster home or in a person's own home. The major difference is going to be in the care home setting or the home setting. Of course, it's going to be a smaller environment less people versus a nursing facility is going to be a larger environment with more people. They're both going to have their challenges. I would say in the smaller setting right now, the bigger challenges are going to be access. So prior to, you know, where we are right now, I would say a few months ago, it was a little bit restrictive of, you know, homebound, bedbound patients being able to go into the hospitals and the ER setting, again, kind of gearing more towards telehealth. And of course, no system is perfect. So there are going to be things that are missed with that. If you're going into a nursing facility setting, I would say the positives of that are going to be that you have an attending physician there, you have 24 hour registered nurse there. But again, also, there's going to be, you know, challenges to both settings in a larger setting, you're going to have more exposure to more people as well. So it just really depends on what your individual goals are. So how does COVID affect each of those settings? What are some of the questions that I would need to ask in those settings regarding specifically COVID-19? So I would say that the number one thing would be asking, you know, what is each individual facility's protocol? So what is their COVID protocol? So whether that's having visitors and doing thermometer checks, temperature checks? Are they doing active testing of staff? Are they doing testing of patients as well? And what is their protocol for when a patient is confirmed to have the virus? I would say those are good questions to kind of start off with in the facility setting. So what is your protocol for protection? Are you testing your staff? Are you testing your residents? And if you have had a case, what has been your procedure? Is that what you're saying? Right. And I can't speak to as what facility is going to be able to explain, you know, their history with any confirmed cases. But I think every single facility definitely does have a protocol in place for when something happens, and they all are a little bit different. And then when it comes to hospice care as well, you know, I think one of the biggest challenges that we are seeing right now with the entire virus affecting all the facets of our society is that we are kind of feeling ostracized. And in the same aspect, we are feeling that way when we're going into a nursing facility setting because like the statistics you talked about, our highest risk population are the elderly population. So the way that we can protect to them in a nursing facility setting is by minimizing the amount of people that are led in. And that side effect is going to be that families are not going to necessarily be able to see their loved ones as much too. This is a tremendous impact, it seems to me on hospice care because the hospice team is oriented towards enabling the patient and family to have the richest experience they can have with each other in hospice relationship, in the hospice relationship. You mentioned telehealth, what's telehealth? We use that all the time, but perhaps people don't know what telehealth means. Sure. So telehealth is going to be, you know, virtual. So whether that's using a specific type of app, whether that be FaceTime and there's all sorts of different brands and companies, but it's really just doing things virtually. Telehealth could even just be a phone call or it could be actually a video-to-video conference like Zoom. So it is generally speaking an internet or a non-president, non-face-to-face connection that can be made. I think are there some facilities that are really active making this happen? There are facilities that are actively making it happen, but I think that the biggest challenge is that, you know, whether the staff can do it at the need or the desires of the family and the patient. So it would require, you know, somebody from the facility setting getting an iPad or a phone or something like that and going to the patients from and doing it. So how often that's going to be and also at the same time to for our patients with Alzheimer's and dementia, how much interaction are they going to really be able to be having over a phone call or a video conference is going to be limited. So of course, you know, nothing is really going to substitute face-to-face interaction, but unfortunately that's kind of where we are right now in our system. And this is affecting people across the board because it's preventative. We're not saying only for patients who have COVID-19, but it's preventative. How effective do you think the preventative precautions are, Erin? Well, I think, you know, Hawaii is probably one of the most strict. So we have completely, if not completely, shut down a lot of our nursing facilities to visitors interaction at the end of life. It is possible, but it's restricted to potentially maybe one visitor at a time. Whereas some other facilities on the mainland were having much more visitors, their contamination rates for COVID were much, much higher than ours. Right now is about 1%. So I think that's really good. However, you know, I think the positive of this entire situation is that we are decreasing our exposure and our loved ones. And even though it's difficult, and even though we are not able to see them as much as we would like, unfortunately, we don't have any other way of controlling this because the only thing that is spreading this is people, right? So that's the only thing we can control at this point. I think it's difficult for family members. And if I were a family member with such a situation, it would be difficult for me to be in a position where I cannot be with my loved one at the end of life. And to say, I do this, and I agree to this, because it is protective of the healthcare system, it is protective of others, maybe even protective of me. But that's a big picture kind of approach to things. That's a big picture kind of approach. So how things functioning in the, or what are some of the PPE, the personal protection that we, equipment that hospice people are using? Sure. So the general ones are going to be our surgical face mask, our face shields as well, gloves, you know, following CDC guidelines, washing your hands. If you have a temperature, obviously not going to work. And doing active testing when you are under investigation or you having any symptoms that you think. So those are typically what are being used right now. Testing for temperature and what's the temperature limit? So for right now, I can't speak for all of them, but anything above a normal or 99 or 100 is definitely something that they would be concerned about. And then any other symptoms. So a lot of other screening questions, I think a lot of people have experienced them when trying to go into the hospital or visit family members. So are you having a cough or any respiratory issues? Have you been with somebody recently in the last two weeks who is under an investigation or is a confirmed patient or been exposed to anybody or traveled from somewhere as well? And I know that's a big issue or a big challenge and concern right now too is that we're opening up the state too to visitors. This may seem trivial to some of the viewers, Erin, but I have a story. I mean, not the story, but I think this high level of precaution and tracing the initial kind of tracing questions. Have you been close to somebody with it? Have you have you traveled them? They may seem like trivial questions, but I have a story that I read this morning that really, really threw me. And it was about a woman who was a nurse and she said her husband went out as things were opening up. They went out for, I think in March, end of March or first of April, he went out to Home Depot for a run, a man run to Home Depot to pick up some stuff, came back and he was wearing a mask. But when he got back to the home that evening, she looked at him and said, what's wrong with your eyes? They look a little puffy and red. And he said, oh, it's just allergies. And those allergies, apparent allergies turned out to be symptoms, which he in turn spread to their two children, which in turn became her experience of COVID-19. And she describes the experience of the disease and all that she tried to do and was to do. And it was just really horrendous experience. And the title of her story was One Visit. One Outing Infected My Whole Family. And so these are not trivial concerns. And how can we improve? Is there a way that we need to focus some improvement? Here's a question that came in. What or where can we improve Hawaii regarding COVID-19? Sure. So I think that following the other examples that we can from the Maiman, doing a lot more active testing, I think that if we can increase our testing ratios, that would be very helpful as a state. And also increasing our PPE access for just the general public as well. I can't speak on that example of going to Home Depot and that being the one and only point that they received anything. But definitely increasing our PPE, our testing, as well as really just again trying to get out back to the public and it is okay and it is safe for them to go in to see their physicians, to go see their PCP, their general practice physicians. And if they do have any concerns or anything like that, really addressing them. Because I think what we have done and what we are experiencing is that a few months ago the situation was completely different. And we have to remember that in December, this wasn't even on the map of America. And so every single day we are constantly learning things and a few months ago it was, right now we have to reserve our PPE, don't go into the hospital or emergency room unless it is absolutely necessary. And so in turn what that has created is it has created a larger population of people who have normal acute chronic illnesses, who are not going into their general practitioners or their primary care physicians. And this is then also leading to a decline in potentially them getting their normal medications or addressing a small symptom that could exponentially turn into something much larger. So really going back to that idea of please go in and see your healthcare professional, I think that may change this right now. And then now with telehealth as well, that is something that is going to make it easier for people to access their physicians. So I hear you saying don't stay home if you are sick just because you are afraid it is going to be COVID. Is that what you are saying? I don't want to say don't stay home but I would say reach out to your PCP or your healthcare professional because at the same time we don't want somebody who is symptomatic going in to a physician's office building and potentially getting a whole bunch of other people exposed if they are confirmed positive and they just haven't had the test yet or something like that. But definitely at the same time I think we have seen a lot of patients going into the emergency room who are much higher level of acuity as well. And so were they not, you know, if they had contacted their PCP would things be different? We don't know. All we can do is kind of move forward and just say let's have some more communication involved even if that's telehealth. Well we have a couple of questions that have come in. What are the biggest challenges in reopening the state? That's a big question. I would say probably the same challenges that we are experiencing and have experienced which is going to be number one PPE. So prior to this you know when the state was completely closed a lot of the healthcare companies, hospitals, we ourselves were having a very difficult time getting PPE. And it's because the general population all of a sudden wanted surgical masks, they wanted gloves, they wanted sanitizer, all of that sort of thing. So you know with increased demand there's a increase in cost and a decreased accessibility to it all. So having available PPE and then also prior to this we were not requiring or having a need for surgical masks in a restaurant or in the food service industry or the airport. That is going to be adding hundreds of thousands of a need to it. So just the fact that Hawaii you know prior to this we had about 45,000 people in a month coming in as tourists. Just exponentially thinking you know even if we were to do a third of that that's going to require PPE as well. So that's going to be a major challenge and then I think the other one is going to be contact tracing and the quarantine as well. If people are going to be taking their COVID test before they come here and and then also monitoring them while they're here for quarantine or not in quarantine. Those are definitely the biggest challenges. Excellent, excellent response. Thank you. Here's one more viewer question and thank you so much you all for asking questions. What are your thoughts on large plastic screens with the patient on one side and the family on the other so that they could embrace one last time? Sure and just to clarify embrace meaning being able to physically see each other versus hugging right. So the dilemma and I think it's an excellent idea however the dilemma would be that let's say a person does have it's going to be a different scenario of a person has it confirmed and they are actually currently confirmed with COVID-19 versus if they're not because it doesn't mean that we're completely ostracizing all of our elderly. If a person does not have confirmed COVID-19 I think that things are are much more different than what we're looking at here and in that scenario it would be okay for them to be at bedside but it's just we have to keep social precautions in mind. So prior to this we were able to have 15, 20, 50 people potentially in a home at bedside while a person was transitioning. That is not the scenario right now just because of you know people being asymptomatic carriers and so forth but if it is one person at a time in a room and that person doesn't have any issues or isn't confirmed I think that you know that's that's different of the different story. Thank you thank you thank you and I think the impression I get is if there's the face shield on a visitor would enable that hug and embrace. Yeah yeah so a lot of the facilities are you know they're allowing one visitor at a time and they just have to go through the screening process as well so the temperature checks answering the normal COVID screening questions and then they are able to be at bedside it's just that it's it's limited. I would say that my experience is that the that the hospice and the facilities are attempting to be sensitive to each case and the parameters of each each patient's needs and family needs. Hospice specializes in recognizing infectious disease controlling it within that one patient and the family and specializes in enabling families to come together at those the times of loss and if it's there's not an infection I mean if there's not an immediate urgence concerned about the person's COVID status or infection then there are ways that hospice can enable that last embrace to to happen we've only got about three more minutes just in a minute I read that most insurance companies do not cover COVID is that true um and I guess my question would be when you say does not cover COVID do you mean does not cover COVID testing does not cover COVID treatment because that's a that's a big discrepancy right a COVID test is a simple lab I'm sorry as treatment I the the first thing that comes to my mind is there is no cure for it right now right so the the treatment would be probably symptom management and at best that would be you know our our medication or if a person is very severe they would be hospitalized and they would be on you know potentially worst case scenario an event whether or not a person's or how much of a percentage their insurance will cover it I really can't say but I think it would be as if a person did have a stroke or some other serious acute illness that did require them to be on event it would probably be similar but I don't think that the government has enacted any sort of um you know blanket covering disease state insurance coverage thank you the last thing Katie Porter was uh interviewing redfield cdc um official and she said will you commit now to making sure that everybody in the united states can get a test if they want it he tried to hedge it and she said no will you commit and he said yes everybody will get a test we'll fund it so she broadcast that how you feel about that so I have not been able to see anyone who has not been able to get access to a test so even if a person does not have insurance there is the aloha free clinic in kalihi and they can go ahead and get one there there's all sorts of resources out there to be able to get tested because ultimately no matter if you have insurance or not we do as you know a health community want to track where this is and and where is it going thank you erin hamilton personal hospice community development person come back in two weeks for elderhood aging gracefully and my program continues thank you for think tecawyan please go to think tecawyan make a donation this is an incredible gift in our community uh to to uh air these kinds of things and i wish you mahalo i'd say mahalo and i wish you aloha it's been a great time thanks again erin