How Ballarat Hospice meets end-of-life care needs amid COVID-19

For six months the lady had not hugged anyone in a bid to stay safe during the pandemic, but a hug was all she was after.

Palliative care nurse Sharon Moss said that need highlighted an acute loneliness among her patients at their most vulnerable in a challenging year.

That personal touch and being close to patients, comforting them, was all-but-gone for Ballarat Hospice Care workers across the region. They underwent specialty training in facial expressions focusing on the eyes - their eyes and how to read the eyes of patients and carers but goggles, face shields and other personal protective equipment created a distinct barrier that was hard to overcome.

Palliative care needs in the region sharply rose this year with Ballarat Hospice Care recording a 43 per cent increase in at-home deaths in their cases. Others were seeking palliative care for complex and high-risk cases as a way to stay out of hospital as much as possible during the pandemic's height.

Phone calls became increasingly vital, like in many health services, to ensure patient needs were met. Ms Moss said for many, it was far more than just seeking medical advice or instruction - they just wanted and needed to talk.

"They're the things that really came clear in COVID," Ms Moss said.

More people were turning to Hospice for end-of-life care at home in fear of looming isolation under strict hospital visiting conditions this year. Ms Moss said it made for a busy year, but the outcome had been better for families where home care was possible.

"There are a lot of people who don't want to be at home if they feel they will be a burden on their loved one but a lot more end-of-life patients requested to be at home this year and found it could be achievable with the right support," Ms Moss said.

"In my 25 years, patients haven't changed and the carers haven't changed. They are all just as courageous."

Ms Moss started with Ballarat Hospice Care as a volunteer nurse in 1994 before a job came up. When she started, Hospice was based in a Talbot Street house averaging 10 patients and Ms Moss said staff would wait every day for referrals to arrive in the mail.

Now, not long moved into a multi-million dollar purpose-built facility, Hospice averages about 220 patients at a time.

Ballarat Hospice Care chief executive officer Carita Clancy said the increase demand for support this past year had offered a good indication for what was needed, in staff and resources, to help a growing population with more people wanting to be at home longer and to die at home.

Ms Clancy said there had undeniably been challenges in keeping staff and patients safe but clear guidelines from Victoria's health department helped. Hospice also had long-standing relationships and support with Gandarra palliative care unit and oncology teams at Ballarat Health Services and St John of God Hospital. General practitioners also stepped up in case management.

More Hospice staff worked weekends and after-hours, particularly for needs when patients were deteriorating and crisis support was needed.

"Our main concern was to keep our staff safe. They have families and their own communities too," Ms Clancy said. "There were impacts in the importance of testing - our results were all negative but there is the emotional impact on waiting and working from home.

"...Our challenges, like all frontline workers, was in personal protective equipment...that impacted sensitive conversations. That's been hard because normally our staff work close with patients, not only in words but in actions, and we've had a limited ability to visit people at home."

Ms Clancy said trust in Hospice's long-standing staff had been invaluable to best meet community needs.

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