Hospices Refocus on Staff Mental Health During COVID-19

The coronavirus pandemic has elevated attention to the mental health needs of the hospice workforce. Hospice executives have increasingly focused on providing new avenues of support for staff as they are buffeted with waves of COVID-19 challenges while caring for high-risk patients and their families.

Workforce shortages and staff burnout have been ongoing issues in the hospice space. Working with dying patients and their families can be overwhelming and lead to anxiety, depression and compassion fatigue. As the pandemic amplifies these needs, stakeholders in the field are recognizing that staff need additional support.

“The pandemic has brought an additional light on a subject that’s always been really important in hospice and palliative care,” said Michael Milward, former CEO of Hospice of Santa Cruz County and strategic advisor to the National Partnership for Hospice Innovation (NPHI). “Issues of work/life balance and self-care have certainly been active in conversations in my experience. Dying is hard work and dealing with death and dying on a daily basis has its own challenges. Supporting patients and families involves a great deal of complexity, family systems and social systems around what’s happening. That’s all just been heightened by the changes that have been asked of us in the pandemic.”


Hospice workers face personal risks of exposure to COVID-19. While personal protective equipment has aided providers in their ability to protect employees, the risk of contracting the virus and spreading it to loved ones has heightened stress and fears among staff. Additionally, the need to socially distance has impacted the ability to provide hands-on care and comfort to patients and families nearing the end of life. Many have passed in isolation without loved ones nearby, placing a tremendous strain on those who care for them.

“The isolation that we’re feeling is one of the largest drivers of anxiety and stress that people literally live in fear every day concerned about their lives,” said Tom Koutsoumpas, president and CEO of NPHI and co-chair and co-founder of the Coalition to Transform Advanced Care (C-TAC). “You’ve got to put all your efforts and energy into providing that love, support and care that hospice and palliative care workers do every day, yet they’re also struggling personally. Looking for ways to support each other and really helping each other through this period with professional support as well as personal interaction is really critical.”

NPHI recently joined forces with the National Alliance on Mental Illness (NAMI) in a series of biweekly discussions aimed at leaders working to staff during the pandemic, including best practices on promoting mental health and eliminating some of the barriers to access.


“It was a wonderful opportunity to sit down with the folks at NAMI and really have a great discussion about how we in our organization could work with them and partner with them to enhance the opportunity for mental health support and creating a stigma-free environment,” Koutsoumpas told Hospice News. “Developing this relationship is a great way for us to begin looking carefully at the things we need to address and show support for, and not do it on our own but do it with the nation’s leading organization in mental health support. We really learned about all kinds of support services out there to tap into.”

NPHI’s partnership with NAMI brought in additional resources such as a help hotline for workers and access to counselors, psychiatrists, psychologists and various other mental health support services. Increasing access to confidential and free assitance was an important step in breaking down barriers and providing staff with the help needed to weather the COVID-19 storm.

“That’s really been tremendous that people know help is there, whether they access it immediately and need it or not,” said Koutsoumpas. “There’s a sense of relief that they’re not isolated and alone worrying. There’s a place to go, to call and there’s support out there. I think it’s provided a level of comfort that is extraordinarily meaningful.”

Encouraging employees to take advantage of resources and programming has come with its own hurdles for hospice executives and leadership. Many workers have difficulty coming forward to express and address their own needs as they care for patients and their families during a pressing time.

“Hospice workers tend to be excellent caretakers and providers of comfort,” said Benyamin Cirlin, licensed social worker for Visiting Nurse Service of New York (VNSNY) Hospice Care. “However, this does not always lead to good self-care. Too often, larger-than-normal caseloads cause hospice workers to put their own mental health needs behind those of the patients they care for.”

Employers need to encourage staff members to engage in support groups that are anonymous, according to Willis Partington, VNSNY’s lead bereavement counselor. The organization’s hospice bereavement and emotional support team were recently recognized for their efforts in a report highlighting teams who played pivotal roles during New York’s response to the coronavirus crisis.

“There should be a variety of groups so people feel that their experience is being supported and they can participate however they wish — even if that means just listening,” said Partington. “Agencies should also designate staff members to engage in individual sessions for stress debriefing.”

Heightened awareness was brought to the severity of mental health impacts when two New York City health care workers committed suicide in April this year. They served in areas that were some of the hardest hit by COVID-19. Friends and family of both workers cited anxiety and pressures of coping with an onslaught of infected and dying patients as leading contributing factors.

“Hopefully one of the learnings that is coming out of the pandemic is that we really need to up our game,” Milward told Hospice News. “Leadership and culture needs to be very involved in helping folks recognize when they need support and supporting that need when it arises. We’re life-long learners in hospice. We would never choose this pandemic, but I do think there are lessons to be learned here as well. It’s important that we pay attention to what’s changed and what we want to have ahead.”

Some stakeholders have advocated for continuing employee access to mental health and wellness services beyond the duration of the pandemic could improve quality of life for staff, and possibly improve morale and retention.

“It’s not just the sudden and severe emergence of COVID-19 that we need to learn from,” said VNSNY’s President and CEO Marki Flannery. “It’s the lasting effects and lingering impact of the pandemic that we must keep in mind. We can’t know what lies ahead, but we can listen, learn and keep our people strong.”

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