AUSTIN, Texas — The elderly population and people with weakened immune systems are most at risk of COVID-19, but some hospice workers say not enough precautions are being taken to protect our older friends and family members. 

Michael Giles was a social worker with Heart to Heart Hospice, but left the company because of its response to COVID-19. 

As a hospice social worker, his job is to go into nursing homes, assisted living facilities and hospitals caring for dying patients. He says Heart to Heart Hospice pushed him to continue making as many of those visits as possible throughout the pandemic, even after facilities started denying workers at the door.

"We had to show up and be told that we couldn't enter instead of working on partnering and collaborating ahead of time," Giles explains. 

Hospice workers have been deemed essential employees, but Giles says not every visit is essential. In fact, the visits may be causing more harm than good.

"Going into a patient's home definitely becomes more dangerous if you've been to several other patients' homes during that day," Giles says. "It becomes far more dangerous if you've been to a nursing home that day, far more dangerous if you've been to several nursing homes and a couple of hospitals."

Giles believes there are certain instances when hospice care is essential, but other times workers are doing routine check-ins that could be just as effective via telehealth. 

Jason Myers, a chaplain with Heart to Heart Hospice, says a lot of the grief services he provides can be done virtually. He says when he brought up the idea of limiting in-person visits to management, he got pushback. 

"The focus was just on remaining fully operational rather than thinking about what's best for the people we serve, what's best for our workers."

Giles and Myers worry the company is side-stepping guidelines so workers can continue making visits, and therefore maintain their relationship with the nursing facilities. This isn't only happening in Texas, but also at hospices across the country.

We spoke with one hospice worker in Atlanta who wishes to remain anonymous. She says she's being pushed to keep making as many visits as possible, even being told to lie to staff at facilities for the sake of the hospice's reputation. 

"Most of them will let me make the initial psycho-social visit when a patient comes on to service, and I think that they don't realize that they have the option not to, but I'm not supposed to inform them. They feel like if we say we continued to provide services during the COVID pandemic, that it makes them stand out, I guess," she said.  

Another social worker in Phoenix says staff at her company is still making visits, despite the fact one of the chaplains contracted COVID-19, then exposed workers in an all-staff meeting. 

"Nobody was told, none of us were told that we were exposed to it. I mean, what population is being affected the most? Most of our patients are 80, older than 70, all the way up to 100 and something years old." 

All four workers say they got into the business to provide support to one of our most vulnerable populations but that their companies are preventing them from doing so. 

"If I were to be exposed to the virus, then I would not be able to attend in the crucial situations where I'm really needed," Giles said. 

We reached out to Heart to Heart Hospice for comment. They have not returned our calls or emails.  

We spoke with The Texas Health & Human Services Commission about these claims, and they sent the following statement:

Although hospice workers can be considered essential, recent emergency rules enacted April 3 allow nursing facilities to restrict visitation to certain personnel in order to limit the spread of COVID-19. Although health care workers are not prohibited from working at multiple facilities, providers are urged to follow the most recent CMS guidance related to staffing (attached PDF).

Our recent COVID-19 guidance to Long-Term Care Facilities is also available online.

We also wanted to make you aware that Governor Greg Abbott issued new executive order GA-16 today on this issue. Here is the portion relevant to your question: 

“Nursing homes, state supported living centers, assisted living facilities, and long-term care facilities should follow infection control policies and practices set forth by the HHSC, including minimizing the movement of staff between facilities whenever possible.”

We will be working with the long-term care facilities we regulate to implement this new direction and, through ongoing monitoring, ensure they have sufficient staffing to safely serve residents. 

In the meantime, we have been directing these facilities to follow CDC guidance to assign staff to certain patients and residents to the extent they can to decrease the number of different staff interacting with each patient and resident, as well as the number of times those staff interact. This includes guidance that staff as much as possible should not work across units or floors, and facilities should dedicate only specific staff to work with COVID-positive residents if they have that capability. 

And finally, we are directing facilities to continue with vigilant daily screening of all staff for symptoms of a respiratory infection – before they enter the facility to start their shift – in addition to practicing all required infection control protocols in accordance with DSHS and CDC guidance.