Preserving Family* Presence During Challenging Times ......2020/06/16 · © 2020, Planetree...

Preserving Family* Presence During Challenging Times:

Principles and Practical Strategies

*’Family’ as defined by the patient or resident, including friends, neighbors and/or relatives

Presenters:

• Susan Frampton, PhD, President, Planetree International

• Penny Cook, MSW, President & CEO, Pioneer Network

• Marcel van der Priem, Director, Rivas Zorggroep, (The Netherlands)

• Patrick Charmel, President & CEO, Griffin Health Services (Derby, Connecticut)

• Tania Hobson, Executive Director Allied Health at Children’s Health Queensland Hospital and Health Service (Queensland Australia)

Housekeeping Details

• Questions?

• Slides and recording of webinar will be sent to all via email

• 1 Learning Credit earned toward Fellows in Person-Centered Care credential

www.planetree.org/fellows

May 6, 2020

Unintended Consequences of Restricting Family Access

A Shared Conviction: Safe, Responsible, Compassionate Family Presence At All Times

Download at bit.ly/familypresence

The Guidelines

1. Assess whether there is a need for restrictions to family based on current factual evidence. Continually reassess and adjust policies as conditions evolve.

2. Minimize risk of physical presence by following appropriate infection control guidelines issued by the World Health Organization (WHO) and local and regional health authorities.

3. Communicate what to expect proactively and with compassion so families do not appear at a facility unaware of restrictions that have been put into place.

4. Establish and clearly state compassionate exceptions to family presence restrictions, for example in end-of-life situations.

The Guidelines

5. Support meaningful connections to minimize isolation in cases where family is unable to be physically present, using virtual or other means.

6. Inform and educate in cases where family can be with their loved one physically, adopting a shared decision-making approach to communicate the risks and benefits.

7. Enlist family as partners for quality and safety, engaging them as members of the care team who share in the responsibility for abiding by established safety protocols.

8. Enhance discharge education and post-discharge follow-up to support successful transitions of care, especially when family have not been present during a hospitalization.

PRACTICAL STRATEGIES: EXPERIENCES FROM THE FIELD

Patrick Charmel, President & CEO

Tania Hobson, Executive Director Allied Health at Children’s Health Queensland Hospital and Health

Service, Queensland Australia

Marcel van der PriemExecutive Director

Rivas Zorggroep

Family Presence Today at Rivas Zorggroep

Rivas Zorggroep– Hospital Care, Rehabilitation Elderly People, Home Care, Nursing Homes– The Netherlands, Rotterdam area, 4000 employees– Nursing Homes Rivas: 1000 residents elderly people in 17 Nursing Homes– Planetree Gold Certified for Excellence in Person-Centered Care

Context: • In the Netherlands, people with dementia and somatic diseases stay 2 years in nursing

home before death (average)• Nursing Homes are capable of low and medium medical care

Community Spread in the Netherlands (17 million people)

Incidence rate Netherlands: 285,91 per 100.000 people

• Nursing homes, COVID-19 experience– Nursing Homes Rivas: 1000 residents of elderly people in 17 Nursing

Homes– 8 Nursing Homes with outbreak– 103 people (10%) COVID-19 residents between March - June– 28 people died

Family Presence Today at Rivas

Timeline • March 18th Nursing homes were closed for visit of family (government policy)• April Rivas made a national Guideline “Visiting Policy Nursing Homes”

– Guideline was made to develop an alternative to government policy to close all nursing homes in the Netherlands

• May 11th A nursing home of Rivas is one of 25 pilots for restart visiting • May 25th each Nursing Home in Netherlands without Covid 19:

– one visitor per resident a week; symptom and temperature screenings at entry; masks and instructions on physical distancing provided at entry

– Following the containment of community spread and decreasing cases

• June 15th two (non unique) visitors per resident a week• July 1st more visits a week, screenings at entry and testing policy

Challenges to maintaining a person-centered approach to family presence

• In last months of life, family presence is essential for human dignity– Residents autonomy and free choice VS governments safety perspective– Families that want liberal policy VS families that want to keep all safety measures– Employees that want liberal policy VS employees that want to keep all safety

measures

Context: In society there is more flexible policy (public transport, schools, sports, restaurants, holidays. -> not explainable to families and residents

Advice and Future Plans

• Make decisions through policy framework• So……even when local incidence rate is

increasing– If there is screening at entry and active testing for

residents and employees– And (masks and) instructions on physical distancing

provided

Family presence should be the residents’ and families’ choice

Human Dignity

Safety (of all residents)

Autonomy of residents

Policy Framework

Family Presence Today at Griffin Hospital

• Griffin Health Services– 160-bed acute care community hospital with 1,000 employees located in southern

Connecticut, USA– Located approximately 70 miles from New York City– Planetree Gold Certified for Excellence in Person-Centered Care

• COVID-19 experience– Treated over 170 COVID-19 hospitalized patients between March – June 10th– Community spread of the virus is now contained in the region

Family Presence Today at Griffin Hospital

• Griffin has had a patient-directed visitation policy for over 20 years, with patients choosing who/when visitation occurs

• Care Partner program has been in place for over 15 years• COVID-19 policy changes included:

– One visitor at a time for non-COVID patients for both the E.D. and inpatient, exceptions on the number of visitors were made for humanitarian and end of life situations, allowing for more than one visitor at a time

– Symptom and temperature screenings as well as masks and instructions on physical distancing provided at entry

– For COVID-19 patients, visitors were not allowed, with exceptions made for humanitarian and end of life situations

• Women in labor coming from other regions, including NYC, arriving at the hospital wanting to receive care at a person-centered facility that allows a birth partner

• Families familiar with Griffin’s person-centered model of care expecting more liberal family presence policies even during the crisis

• Area residents who usually use another regional hospital deciding to access care at Griffin due to the perception that it is safer than more restrictive hospitals.

• Base your policy decisions on facts as they emerge. If you have community spread under control, and access to screening and PPE, then why would you limit family presence?

• Recognize that a hospital’s visitor policy creates a consumer perception about facility safety which has implications as to whether consumers continue to avoid using hospital services due to fears about COVID-19 exposure

Assessing Consumer Perception During COVID-19

Public Opinion Strategies conducted a survey to assess public perception of the U.S. Healthcare system. The study was conducted during the period of April 16 – April 20. It was a national online survey of 1,000 adults.

Asked to rank on a 10-point scale how safe they feel going to a medical facility right now, half of respondents said 5 or below, with a mean score of 5.4. More than a third (37 percent) said

“feeling unsafe in a hospital setting” may be an obstacle to seeking future elective treatment.

Safety Concerns Resulting in Avoidance of Needed Care

Where Have All the Heart Attacks Gone?Except for treating Covid-19, many hospitals seem to be eerily quiet.

By Harlan M. Krumholz, M.D.NYT April 6, 2020

Consumer Perception During COVID-19

Be an advocate for person-centered care in your region, and share your guidelines and experiences

with others to increase their comfort level

Children’s Health Queensland Hospital and Health Service

• Located in Queensland, Australia• Population of Queensland = 5.11

million• 1.3 million children and young

people (aged 0-18 years) in Queensland

Family Presence Today at Children’s Health Queensland

• Visitation and Access during COVID-19 Pandemic Period– Visitation:

• Visitor restrictions• All visitors to follow strict hand

hygiene processes, social distancing and respiratory hygiene

– Access:• screening at entry points

including screening for symptoms, recent overseas travel, and temperature checks

• Declared a Public Health Emergency– Keeping pace with policy direction and

alignment with public expectations– Clinician expectations and response– Hospital infrastructure configuration

• Ensure ongoing alignment with the government policy

• Seek advice from expert clinicians• Enable the front line inter-professional

teams working with patients and families

• Continue to partner with consumers and other organisations

• Engage and listen, support consistently, communicate clearly, and take action.

Virtual visits at Queensland Children’s Hospital

Birdie’s Tree:Growing together through natural disasters and disruptive events

What You Can Do to Preserve Family Presence

• Advocate for responsible, compassionate family presence. Share these Guidelines and your experience.

• Question measures that seem overly restrictive. Are they fact-based? Are they appropriate to the current moment in time?

• Partner with patients and families to determine what “essential support” means

Additional Resources/Guidance

• https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-recommendations.html#manage_access

• https://www.cms.gov/files/document/covid-what-patients-should-know-about-seeking-health-care.pdf

• https://www.who.int/publications/i/item/10665-331495

Additional Questions?

Send to sguastello@planetree.org

Thank you

https://www.planetree.org/person-centered-pandemic-

resources

https://www.pioneernetwork.net/resource-library/

The larger goal: Maintain safe, person-centered healthcare systems around the world

Nothing about me, without me!

I am a person, not a condition…

Every patient, every time

Putting patients first

Care focused and organized around the health needs and expectations of people and communities rather than on disease

Quality, Compassion, Partnership

Preserving Family* Presence During Challenging Times ......2020/06/16 · © 2020, Planetree...

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