This column is an opinion by Courtney Sas and Dr. Alexandra Rendely. Sas, a clinical social worker at a University of Toronto affiliated hospital, has a master’s of bioethics and is an adjunct lecturer at the UofT Faculty of Social Work. Dr. Rendely is a staff physician in physical medicine and rehabilitation at the University Health Network’s Toronto Rehabilitation Institute. For more information about CBC’s Opinion section, please see the FAQ.
Overflowing intensive care units and crowded inpatient hospital wards have dominated the COVID-19 public discussion, but what about the patients on the other hospital floors? Think about the daughter admitted with pancreatic cancer, or the grandfather who required an urgent surgery and a prolonged rehabilitation stay – how has COVID-19 affected them?
These patients have received heartbreaking news and endured life-changing events, primarily alone.
As health care clinicians we have seen first-hand, personally and professionally, what it is like for patients to be admitted to these “other hospital floors.” Feeling lonely, isolated and depressed has been a common theme.
Throughout the COVID-19 pandemic, hospital visitation policies have fluctuated out of necessity to match the ebb and flow of the spread and severity of the virus. While the logic of strict visitation policies is clear and maintaining the safety of patients and staff continues to remain a top priority, one cannot shy away from the alarming reality that these policies have threatened human dignity and had an impact on the recovery of patients.
Too many patients have coped with medical complications and hospitalizations without the support of their loved ones. Social and emotional support during a hospital admission is crucial, and the changing visitation policies, while necessary, have had devastating consequences.
Loved ones are more than visitors. They provide clear health care benefits and are an integral part of a patient’s care team.
Visitation polices cannot be a line in the sand, but instead must be considered as part of the medical treatment plan – particularly now that vaccines are becoming available in Canada – because they affect the well-being of patients. It must be recognized that just as the health care system provides individualized medicine to each patient, visitation policies should have the same personalization.
Hospital visitors play a critical role in the care of patients. They help reorient delirious patients, communicate with those who aren’t proficient in Canada’s official languages, and monitor the progress and regression of their loved ones.
A side benefit is that they can help with personal care needs, easing the burden of nurses and personal support workers.
In a world where we communicate online now more than ever, it is easy to forget that patients with hearing impairments, vision impairments, and cognitive disorders cannot always use their devices to connect with loved ones easily. The same is true of some who have been through serious medical procedures.
A young mother who had multiple surgeries in the spring, for example, described her hospital experience as “traumatizing.” She did not have the energy to use her own devices post-operatively, and her family had no way to communicate with her directly. As she was required to stay in her hospital room due to infection control regulations, she had limited daily human contact. She described her experience as feeling as if she were in “solitary confinement.”
She missed her spouse and toddler, and not knowing when she would see her child again was unimaginable. Eventually, when she could connect with them over video, it resulted in a flood of emotions. Those few, precious moments were psychologically and physically exhausting.
In our shared experience as health care providers there are also days when language barriers make it difficult to communicate easily with patients without family present at the bedside. Telephone interpreters are useful to an extent, but do not replace in-person translation, especially from a familiar face.
Are we delivering sub-par care to these patients by preventing visits from loved ones? Are we sacrificing some for the greater good?
Is it fair to a patient to be alone and suffering, an experience made worse by their native language not aligning with that of health care staff?
There may not be a one-size-fits-all answer, but these patients must be considered in hospital-policy decision making.
Likewise, there have been hundreds of thousands of goals-of-care conversations that have been forced to occur over the phone, and terminal diagnoses communicated to loved ones through videoconferencing. Patients were robbed of dignified intimate moments with their support systems.
Now take all of those examples and add the complexity of unmet social determinants of health, such as poverty and homelessness. Some patients can’t involve loved ones in these conversations at all – because they simply cannot afford a phone, or their devices lack internet access. This is yet another example of how marginalized and vulnerable people have been disproportionately affected by COVID-19.
These are the real, unintended ramifications of closing hospital visitation due to the pandemic. This isn’t a discussion in fairness, this is a call to remind us of all the hospital patients who are on the other floors for things other than COVID-19, and how the pandemic has affected their care.
If visitors are treated as care-team members, they can be equipped with proper protective equipment and possibly offered early access to the vaccine, limiting any potential viral spread. The visitation policy for each patient should be reflected in their medical orders, in keeping with the goals of their current admission.
While hospitals are justified in limiting visitors to control unnecessary community spread of this deadly virus, it also has a high cost to the patients on the inside fighting for their lives. We must consider adapting hospital visitation policies to reflect the contributions of visitors to a patient’s well-being, while maintaining staff, patient, and community safety.