• Mitch Ware

Episode 17: No! You Cannot Come Over and Visit!

Updated: Apr 2

In this episode, Mitch talks about the difficult task of sharing with close friends and family that they cannot come over and visit the person in hospice care due to colds and flu. Depending on family dynamics, it can be very challenging. Mitch offers options to consider in place of an in-person visit and explains how germs are everywhere!



" Families can be hard to deal with, especially at a time like this. They are visitors, and so we all have feelings that need to be taken into account. That could be tough for caregivers, because if you've been doing this a while and you're burned out, that means you're on your last nerve anyway."


Transcript:

Well, Hello. Welcome to another episode of living with Hospice. I'm your host, Mitch Ware I've been involved with hospice for over 13 years, both as a family caregiver and a trained hospice volunteer. I just made a fresh pot of coffee. So come on in. Help yourself and let's chat about something. Nobody wants to have to say Sorry, but you can't visit today. How do I tell people not to come visit without hurting their feelings? Visiting someone in hospice can be difficult for many people. I mean, it's just difficult as it is. Just making the decision to do so could be a very difficult decision for some people to make. But our inherent need is to get closure and to say our goodbyes. And we muster up our courage and we go. Then after you get your courage mustered up, you're told Sorry, you cannot come and visit today. No visitors. As we're doing this recording, we're in the midst of this cove. It 19 virus pandemic and most facilities air closed stores are closed, factories air closed. This is really impacting our hospice community as well. Is eldercare community in general? Let's face it, people hospice care have a very fragile immune system. They may be extremely vulnerable to something as simple as a common cold. Certainly the flu bug that's going around. So it falls upon the primary caregiver to set the boundaries for everything, including rules about visitors. There's an old saying about quarantine areas, and it goes something like, If in doubt, don't. In other words, if you're not sure people should come visit, then don't let them. It's better to err on the side of caution, especially now with this extremely contagious cove, it 19 virus going around. But every year we have fairly contagious and what can be fatal influenza that goes around. If you look at the statistics, gosh, tens of thousands of people die every year of influenza, so this is a timely topic. You're regardless of the covid 19. This is something that we need to talk about because many times people will come in and wanna visit grandma or grandpa and their noses running or they have a cough, and we sometimes forget that grandma or grandpa or whomever has a very vulnerable immune system, and something as simple as a common cold can be fatal to them. So this topic is material irregardless, How in the world can we tell somebody? Especially somebody that's close to our loved ones? No, you can't visit today. Some people take the hint. Other people, you kind of have to use a verbal two by four to get their attention. The easiest way to explain that they can't visit is something like, you know, I'm sorry, but grandma's condition is really fragile. And if she were to catch a cold bug from somebody, it could improbably would hasten her death. That's a wake up call for most people. When they hear that, then you can also add, please and thank you for respecting our boundaries as we're doing our very best to take the very best care of her or him that we can, if they still insist, explain that a simple cold bug could kill her or him. And if they still insist, then just say no that no visitors. Sorry, no visitor. Ah, but life isn't that simple. And some of us have relatives that make things complicated and emotional and personal and could be downright mean. They know your buttons. They know how to push them is yours one of those families that has an interesting or maybe even volatile family dynamic? Well, you're not alone in this case, even though you're nice and you get serious pushback in the form of statements like she's my mother, too, or you can't keep her from me or I'm her only granddaughter. You cannot keep me away and she wants to see me. I know. Well, these are just tough situations to deal with. You have to decide what's morally right. Which decision can you live with? With this current situation that the country's in and really most of the world, it's an easy no brainer. I'm sorry, no visitors today, but once this passes and you're listening to this at a later date, how do I handle a brother or a grandson, your granddaughter or a best friend that wants to come over? But you can see Yuri and you can tell, and it's obvious they aren't feeling well. And as the primary caregiver, you're the one that has to deal with this person. Some people who act like that well, they've always been and probably always will be selfish. They want their own way in everything they do, huh? So what do you do? Well, you can give in and hope for the best, or you can stand your ground and that things escalate to a level that is really not good for either of you. And you probably will regret one day. Yeah, you can try to find a compromise. What's the middle ground? That means the wearing of maybe the in 95 mask and perhaps some some latex or rubber glows late Texas prairie. Not a good idea in case somebody has an allergy, but you get the idea. Exercise. Social distancing. Now that's really hard to do in visiting Grandma or Grandpa or a loved one that is in hospice because you want to get up close. You want thio, maybe reach out, touch their shoulder, and we've talked about that. Weighs two non verbally communicate. You know, scientists tell us germs are spread one of two ways, for the most part, either airborne or by touch. The spread of airborne germs is greatly reduced by wearing a face mask, especially one of the in 95 masks. Wearing a face mask is certainly not an ironclad guarantee, by the way viruses can also transmit through the eyes and tiny viral particles known as aerosols, which can penetrate masks they can get into your body through other areas. However, masks are an effective way a capturing droplets, which is a main transmission route for many of these things. But no matter what we do social distancing masks and whatnot, they're on Lee, effective when used in combination with frequent hand washing, using an alcohol based hand rub or good old fashioned soap and water. Something else I learned the other day is there are a few things we need to do that I never really thought about, for You put a mask on even, and I have been putting masks on. When I go visit patients from time to time for years before putting on a mask, make sure you clean your hands with an alcohol based hand. Rubbed rub or something like that that I carry in my car. And before I see a patient, I always wash my hands. I always gargle. I have some mouthwash. I always make sure I gargle so that my hands and my mouth or clean when we put a mask on you. Want to make sure you cover your mouth and nose with that mask and make sure there are no gaps between your face and in the mask. Have you ever wondered, by the way, why E, M T s and and fireman never have beards? It's because if you have a beard, that mask won't seal tightly. And, of course, for a fireman breathing in oxygen, it's important that that mask fit tightly. But we're learning a lot during this cove in 19 about masks. Also, avoid touching the mask while you're using it. And if you do, make sure you clean your hands with an alcohol based hand rub or good old fashioned soap and water. Why is that? Because hopefully the mask is stopping those particles from getting through into your nose and mouth. So if you touch it with your bare hand, now you've transferred whatever's on that mass to your hands and just like down at the doctor's office. Replace your mask with a new one as soon as it's damp or or it's dirty or after each use, like if you go see one patient, and when you go see another patient, make sure you replace your mask to remove your mask. Remove it from behind. Do not touch the front of the mask and make sure you discard the mask appropriately. Okay, so masks are a crucial part for anyone looking after hospice patients and are also recommended for family members and friends who are visiting and again during the cove in 19. Nobody should visit nobody. But if you're hearing this after the cove in 19 has gone away, hopefully soon, then keep these procedures in mind. So the key here is wash, wash, wash, wash before wash. After, wash your face, wash your hands and you should be okay. Gloves are important, too. There is a reason that health care workers wear them. They stop the spread of germs. Just a simple is that I know it's a pain to wear them all the time, but if you're a caregiver and you're coming and going a lot, then wear them as well as your mask. When people come to visit, they often want to touch Grandma like we said earlier, and they want to tell her, Hey, I'm here How are you in that nonverbal communication? You know that touching to the shoulder, touching of the arm or maybe brushing her hair back with your hand. Make a decision upfront. Caregivers. Are we gonna let visitors do that? If so, are we gonna make him wear a mask? And we're gonna make him wear gloves? I have yet to hear anyone getting pushback about being asked to protect Grandma from colds and flu, especially in the situation that we have right now when it's explained to them properly. Uh, okay. So with all this knowledge, we have a close friend, a family member that just insists in coming over to visit grandma or Grandpa even though they have a small cold and are just feeling a little off, they say, Well, out. I won't get up close. Well, so you have a decision to make. Families can be hard to deal with, especially at a time like this. I mean, it's so many emotional dynamics going on anyway. And when someone's in their 11th hour of life, it's tough for them too many times, even if they're not responsive, that can still here they listen to what's going on what's being said around them. And if you could hook up a heart monitor, you'd see their hearts start to increase. The rate of their heart is beating faster because they're getting frustrated. They don't want to be the cause of this tension. So we have to be careful when we're having these discussions around Grandma or Grandpa. In fact, it's better not to. It's better to set up visitation in advance, at least a phone call saying We're here. Is it possible for us to come in and visit? And that's when you explain to them some of these basic rules in the possible consequences for not following them. And lest I forget not only scrambling going through the 11th hour, we all are right. You are the caregiver. They are as visitors, and so we all have feelings that need to be taken into account. And that could be tough for caregivers, because if you've been doing this a while and you're burned out, that means you're on your last nerve anyway. And you're tired and you're exhausted emotionally, physically, mentally, spiritually, and the last thing you want to do is argue with someone in the driveway who insists on coming in and visiting when you know they shouldn't. So we just have to step back, take a deep breath, get perspective and think about Cem. Cem compromises here. What are some other options? You know there are other ways to visit Grandma that were not available 20 years ago. We now have a big screen, smart TV, and every household seems like just like everybody has a cell phone in their pocket. And most of those smartphones will easily integrate with your smart television. And this allows a large group of people to visit. They use air quotes there with Grandma via what, Skype or or Face Time or some other Web cam technology or whatever app you like to use. She can see everyone on the big screen, and even if she could no longer see, she can at least hear. And sometimes that the patient is blind and having everyone called her and and chat with her over the phone is a great solution. And guess what? I would bet a banana split from house winds up the street best ice cream in the world that you will get more people to call than to actually come to her bedside if they know that's a non option. Why? Because it's tough. It's hard to come see somebody who's dying. Most of us just aren't wired for that. And this is safer. It's more comfortable for them. So offering these alternatives put it on your Facebook page, You know? Sorry, we're not taking visitors right now for Grandma, Grandpa, But, hey, you can call you send me in I am or PM or whatever it is. And I will give you a number that you can call and we'll set up AA schedule so that you can call and talk to her directly. Okay, So you're a visitor, and you see what? Hang on a minute, Mitch. I am very low risk. I'm not with anyone except my spouse. We're both working from home right now. I only get out to go to the grocery store. The gas station? We're both extremely low risks. Well, do you know how many filthy hands have touched the money in your wallet or purse? Paper money can reportedly carry more germs. Then your average household dirty toilet and paper money is like Disneyland for microbes in germs. These bacteria and viruses can live on most surfaces for about 48 hours. The paper money can reportedly transport alive influenza virus for up to 17 days. It's enough to make you switch to credit cards or debit cards, which is what I do. Well, if I use my debit card instead of cash, I found it to be much more convenient. Do you know how Germany the average credit and debit cards are? Debit cards were overall, less gross. Jeremy, then credit cards averaging only a germ count of 243. When you think about it, you're the one handling debit card, right? Just you Okay? Now hold on to your at what's even grosser is that our credit cards are more disgusting. Thin paper, money or coins? The average germ count for paper cash was about 1 60 The average germ score for coins was only 1 36 Every time we scan or swipe or hand off our cards, they potentially acquire thousands and thousands and thousands of microscopic little germ cells. They just want to come visit. And some of them are things that well, I'll spare you any more details. Okay? We won't we'll get in dollar that. Let's just say that these little things air filthy and they need to be wiped out with anti bacterial or alcohol wipes regularly, and we'll just leave it at that. So caregivers, it suffices to say, If you're out and about, you need to wear a mask and glove up. If you're going into the grocery store someplace where there's a lot of people, especially during this cove in 19 situation, you keep hearing people say Wash, wash, wash That's what we need to do. We need to wash our hands for 20 seconds. We need to wash our faces. And, of course, we need to practice social distancing. You know, there are a lot of responsibilities being the primary caregiver. And to be honest, most of it is not fun at all. But like I have said in other episodes, it is worth all of the sacrifice it justice. So it's closed with a quick story. I heard of a situation recently were a gentleman who will call Joe. No, that's not his real name, but we'll call him. Joe was placed into hospice care and was pretty much closing the books. So to speak with his family and friends. He was giving us all of his precious possessions away, and he was really a great guy. Every everyone like this guy. He was always there for anyone in need. He often served on volunteer committees. It was a veteran. Ah, he spent a lot of Sunday's visiting the men and women at the Veteran's Hospital. Like many who served in Vietnam and he was a Vietnam vet, he had a multitude of health issues. But these didn't slow him down any. He was still out and about getting things done, taking care of business, getting people involved in important causes in the community. Well, Jonas wife had raised six kids, three girls, three boys. He had five grandchildren in a great grandchild On the way. Those kids, those grandkids were the light of his life. They were his world. It was a cold day in November that he was told by his doctor that he was near the end of the road. He had a few months left before the Angels would come for him. Well, typical to Joe, he said, I'm I'm going to enjoy this time as much as possible. So he and his wife and some of the family went on a Caribbean cruise. They came home. Joe started making things in his shop, his wood shop for his grandkids, getting ready for Christmas and started a toy box for his great grand son, who was on the way shortly after Christmas. Joe was slowing down. He just didn't have the stamina that he used to have, and his appetite began to wane. The hospice doctors and nurses kept him comfortable, so comfortable that he was able to visit with people when they came over, and he would play cards and reminisce about the good old days. And, of course, diagnose all that is wrong with this crazy world that we now live in. Joe finally got to the point where he could no longer get out of bed, and he didn't talk much anymore. He just pretty much slept most of the day. Joe always loved it when his grandkids would come over and visit. Not sure if you recall, but last year we had a terrible time with school closings. In the winter, it was super cold. It was super icy, so either the weather or the influenza kept the school's closed, and consequently, they weren't able to get over to Joe's house for a visit. Joe Spirits just sank. He was just devastated because he really looked forward to seeing those kids. In fact, that's what he lived for. Then one afternoon, his wife came in and showed him an iPad. On the iPad was his grandson, and his grandson's arms were extended out. And as the camera panned back, there was a brand new baby. Ah, baby boy, Yeah. Joe's great grandson had been born, and Joe's grandson looked squarely into the camera and said, Papa, we've named him Joseph. After his great grandfather, Grampa Joe, smiled ear to ear. He was so pleased tears ran down his cheeks. Needless to say, you know those those were clearly wonderful tears of joy. And I'm sure not only in Joe's eyes but for everyone in that hospital room and certainly in Jo's wife's as well. You know, just because we can't visit somebody in person doesn't mean we can't visit. And just because you can't be there to see something in person doesn't mean you have to be left out. Modern technology is an incredible blessing, and we can harness it to help our loved ones have a richer and more fulfilled life all the way around. Well, that's about it. For today. As always, we really appreciate your thoughts and feedback about this episode, and we want to answer any questions you might have. You can reach out to us via email at livingwithhospice@gmail.com, or by visiting us at our website at www.LivingwithHospice.info. And if you're listening on apple podcasts or one of the other many platforms that were on, we would sure love for you to rate our podcast and tell us that you like us or that you don't like us. Give us some feedback so that we know how we can improve this. And please tell your friends about our podcasts and subscribe today so you won't miss any of our upcoming episodes. Thank you again for sharing your time with me today. I hope you found today's chat helpful. It's okay to say no. If people are sickly, want to come visit and certainly during this cove in 19 situation no. Is a good word to use for anyone who wants to visit. No, I'm sorry. This isn't a good time to come over. So this is Mitch Ware for living with hospice. Have a blessed day.

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