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A MESSAGE ABOUT OPTIONS FOR OLDER PATIENTS By contrast, J. Cameron Muir, a physician with Capitol Caring Health, a hospice and palliative care agency serving greater Washington, D.C., says

his agency has cared for at least 60 COVID-positive hospice and palliative care patients at home, in the hospice's inpatient units or in the hospital. Muir is also chief innovation

officer for the National Partnership for Hospice Innovation, a coalition of 70 nonprofit, community-based hospice members. He says most NPHI member hospices are gearing up to respond to

COVID needs in their communities. They are also committed to policies that allow family members to visit their loved ones in hospice-run facilities. Muir says hospice doctors have also found

ways to use telemedicine, while volunteers have “doubled down on making virtual visits.” But there are limits, he notes, to hospice services that aren't provided in person. “You

can't do virtual bed baths or wound treatments or management of patient-controlled analgesia pumps,” he says. In addition to providing comfort and palliative care during the pandemic,

Muir says hospice can play a role in delivering an important message about older patients’ unique end-of-life care — and their options — during a pandemic that hits older adults especially

hard, and one with no cure or vaccine yet in sight. For instance, he says, questions need to be asked about elderly patients being put on ventilators without seriously considering whether

that course of action is actually the best for them. As he describes it, a trip to the hospital with serious COVID symptoms may well lead to the ICU and, as a patient's condition

rapidly worsens, a swift decision to intubate. There isn't always time to ask the question: “'Do you want to be on the vent or not?'” he says. An alternative to that scenario,

of course, can be staying at home with the symptom management support of a hospice team. “Our message, from a public health standpoint, is that the safest place for many frail elders to be

at this time is in their own homes, whether they are COVID positive or negative,” he says. “The number one message we are still getting from our families: If only we'd known about your

services sooner." Hospice care developed as an alternative to dying in the hospital. While a majority of Americans say they would rather die at home, if possible, many still do not get

that option. Particularly in the COVID-19 pandemic, experts say that choosing not to end up in a hospital, on a ventilator and barred from seeing loved ones, may require speaking up before

the patient reaches a crisis, using tools such as advance directives or Physician Orders for Life-Sustaining Treatment — POLST — and sharing that preference with family members and doctors.

Beckwith says this has been her hospice's challenge since it was founded 41 years ago: “How do you get people to listen to the message that there is an alternative to dying in the

hospital?"