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AT THE time of writing this article, many stringent restrictions for patient visitors that were in place during the COVID-19 pandemic have been lifted, but some restrictions continue in many hospitals, some limiting visitors to only two for a patient, and just one hour per day.
These rules vary from one hospital to another and are still challenging for families and loved ones of unwell or dying patients.
From my patients alone, I could detail several instances where elderly relatives have died with no family members present because of these restrictions. Many family members have described to me the emotional pain from their hospital experiences. The effects can be traumatic for both the patient and the family.
But does it have to be this way? Do we really need to be this strict in hospitals for close family contacts especially for dying patients? Why can’t family members with the right precautions in place – vaccinated, a negative rapid antigen test (RAT), full personal protective equipment (PPE), and clear guidelines – be present with the family member to assist with the small, personal tasks that don’t require a qualified nurse?
Apart from drinks of water, hand holding, assisting with toileting, caring and nurturing, the family can provide emotional and physical support for the patient, more human contact, and ensure they are warm and safe, relieving nursing and other health staff of some of their duties. People understand nursing staff are busy.
Frontline health care workers are significantly impacted by the COVID-19 pandemic. The pandemic and repeated lockdowns escalated community COVID-19 fatigue, anxiety and stress, and contributed and/or exacerbated mental health illnesses (here and here). This placed, and continues to place, great demand on our health system.
The Australian Institute of Health and Welfare estimated that in 2019–20, with the outbreak of COVID-19 in February 2020, the number of emergency department (ED) presentations decreased by 1.4% compared with 2018–19 due to COVID-19 restrictions. A study also demonstrated reduced emergency attendance of regular previous attenders over the COVID-19 pandemic. But in 2020–21, the number of presentations to EDs significantly increased by 6.9% compared with 2019–20.
This burden placed more stress on the medical profession in the community, for GPs and for hospital staff. Doctors and health care workers were and continue to be greatly affected by COVID-19 stress and mental health-related issues.
An Australian survey of 7846 hospital frontline workers (nurses, 39.4%; doctors, 31.1%; allied health staff, 16.7%; other staff, 6.7%), conducted over 2 months in 2020, described feelings of moral distress from exclusion of family in hospitals going against their values (60.2%), resource scarcity (58.3%), wearing PPE (31.7%), limiting their ability to care for patients adequately, and fear of letting coworkers down if they were infected (55.0%). Thus, the exclusion of family visitors is also a burden for health care staff not just for patients’ families.
Another Australian survey organised by the Royal Australian College of Physicians (RACP) found that, in 2021, 87% of physicians were concerned about burnout and feared what ongoing high rates of hospitalisation for COVID-19 would do to the hospital systems that were already stretched before the pandemic. A third of respondents reported they were not provided with sufficient support during the pandemic and could not cope with the increased workload and stress, with over 80% saying they were concerned about staff burnout, reduced capacity to address non-COVID-19 hospital admissions, and concern for delays in screening leading to exacerbations of other medical conditions.
Health care workers across Australia have repeatedly stated the problem is people, specifically the supply of skilled workforce, and when “staffing gaps get very large and the existing workforce can’t be stretched any further, there are longer waiting times for patients, more complaints, more adverse health outcomes. Stress levels and the risk of burnout are sky-high.”
Hospitals have sacrificed so much, and staff have extended themselves beyond their usual work – a recipe for burnout. Since COVID-19-related restrictions have lifted in Australia (eg, mandates for wearing masks and physical distancing within the community), we are seeing a rise in COVID-19 infection numbers especially over winter in Australia. This correlates with the rise of new SARS-CoV-2 variants, contributing to reinfections and another rise in infection, hospitalisations and deaths related to COVID-19.
This is adding to the burden on health professionals and our hospitals.
In view of our overstretched hospital system and staff burnout, why not harness the power of family members or close friends to be with their loved ones, help and provide patients with the emotional and physical comfort they deserve and need especially before they die?
If the family visitors are vaccinated, trained to wear PPE properly, RAT-tested daily to exclude active COVID-19 infection, kept a safe distance from all other patients, and stay close to their loved ones, they can play an important role to comfort the patient, allow their loves ones to die with dignity and comfort, and relieve some of the burden for hospital staff.
Associate Professor Vicki Kotsirilos AM is a GP with over 35 years of clinical experience.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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We understand since the COVID pandemic hit, front line workers are work exhausted whilst trying to protect every single one of us, to keep us safe, to help us move on with this pandemic, but they go too harsh on dying people and family members. Hospital with restricted visitors and times, should give some sympathy in some situations. February this year my grandfather died from liver failure, only hours we learned that he will not make it through the day. My family of 12 including children and grandchildren were notified of this, but only 3 of his children were permitted by his bedside for a few hours. His grandchildren were not allowed to visit due to limited visitors per day. We all begged a nurse for a brief final visit to say our prayers and goodbyes, but in return she told us off badly. She raised her voice and said “in there all patients are dying, I can’t just let everyone in”. We named it the “dying ward” where my grandfather stayed. He passed away alone at 9pm that same day. For him, this loneliness was buried with him underground forever. For us, we still need to move on with life, but each day we are suffering because we did not have the opportunity to say our final goodbye. This is painful, forming a scar in our heart and will stay with us for the rest of our life.
Why does it have to be so strict when we are familiar with PPE and come to this point? Why don’t hospitals permit family members to stay with their loved ones in this “dying ward”, with full PPE, RAT tests etc to allow us to take good care of our dying loved one for a very last time, so the death can be rest in peace, the family do not suffer, to help pressure off our doctors and nurses so they can use their time more efficiently to save people in needed?
I am glad that this topic is being discussed and can we find ways to address this. My father was in the hospital for 8 weeks from December 2021 to February 2022 and was critically ill in and out of ICU and we were not allowed into the hospital for 4 weeks due to lockdown. I hope when the risks are considered the benefits of other lifestyle medicine factors such as social connection, and mental and emotional well-being are also taken into consideration not only for the patients the healthcare staff as well