In a pandemic's dark days, these hospice workers found creative ways to bring light

Hospice worker Michael Russo still sings to his patients any way he can reach them.

(CNN)In ordinary times, music therapy for Michael Russo's hospice patients revolves around glorified home concerts: the troubadour breaks out the guitar, plays Louis Armstrong's "What a Wonderful World" or "Crazy" by Willie Nelson and spreads life-affirming joy during a patient's final days.

But during the coronavirus pandemic, which has prompted hospice facilities to enact strict social distancing policies to minimize the risk of infection, Russo has had to improvise.
Instead of one-on-one sessions in patient rooms, he's embraced Facebook Live broadcasts, video call sessions and even recorded messages.
During a recent house call to hospice patients at an assisted living facility in Punta Gorda, Florida, Russo set up his one-man band on a patio outside a giant window. He was close enough to the lobby so patients could hear him but safely distanced behind glass so he wouldn't risk infecting his audience.
    "Nurses wheeled patients right up against the window so they could see me and hear me and sing along as they would anywhere else," he said. "We weren't completely together, but it was the next best thing."
    This sort of innovation has become commonplace at end-of-life facilities these days.
    Separated from their patients, hospice workers still reach out to them.
    At a time when the specter of Covid-19 looms ominously over public health systems around the world, Russo and other hospice workers are going above and beyond to create joyful and meaningful moments for patients and their loved ones. Some of these efforts hinge upon technology. Others are all about heart.
    Most of the actions constitute simple gestures that typically wouldn't warrant more than a passing "thank you." But in the context of a global pandemic, they loom large and have made a huge difference to people in the last stages of life.
    "Hospice [and palliative care] professionals are trying to care for people in the best ways they know how," said Shoshana Ungerleider, a medical doctor in San Francisco and founder of End Well, a nonprofit and annual conference about grief, loss and dying. "The results have been nothing short of inspiring."

    Embracing technology to connect

    Music crosses barriers between hospice workers and their patients.
    To be clear, patients end up in hospice at the end of long battles with terminal diseases — not because of Covid-19. The threat of coronavirus has prompted hospice facilities to keep these highly vulnerable patients sequestered. This is where the creativity comes in.
    Many hospice workers have relied upon technology to forge connections, facilitating Zoom or FaceTime chats with family members so neither patients nor loved ones feel alone.
    Balu Natarajan, chief medical officer at Seasons Hospice & Palliative Care in Rosemont, Illinois, said his company has encouraged its employees to "bend over backward" to make patients feel comfortable and loved in their final moments of life, even if that means acting as liaisons to convey final thoughts or farewell messages over the phone. He noted that Seasons currently has about 6,000 patients spread across facilities in 19 different states.
    "For us, hospice is about making sure our patients die comfortably," said Natarajan, a medical doctor. "So much of what we're talking about is bereavement, or grief for the living after patients die. A lot of that is simply getting loved ones to make a connection before it's too late."
    Natarajan recounted the story of a nurse who sat with a patient while she died, then on her own volition called the patient's daughter to tell the daughter she was with mom until the end.
    "In that case, the nurse was able to say, 'I was with your mom,'" he said. "It makes a huge difference."
    Other healthcare experts shared different experiences. Ungerleider, for example, remembered a Seattle funeral director who received FaceTime lessons from members of a local Jewish community to manage ritualistic bathing practices on the body of a temple congregant after he died.
    The funeral director wasn't Jewish, said Ungerleider, and he had never performed the bathing ritual before.
    "Because of social distancing, [the funeral director] was the only one allowed in with the body, and he was determined to go through the ritual because the other congregants could not," she said. "He didn't have to do it. He wanted to do it. He wanted to let the man's family and the committee of volunteers from the temple bury him in peace."

    Care from a distance

    In addition to hospice employees using technology to create memorable moments, some have committed to creating magic in person — just far enough from patients and family members to keep the risk of Covid-19 infections low.
    In Dillsburg, Pennsylvania, locals recently teamed up with healthcare professionals to create beautiful and heartfelt chalk murals on the sidewalk outside of a senior living complex in town.
    Kelly Coons, provider relations manager with hospice company AseraCare, was one of the organizers of the event. She said she went early and marked off 6-foot blocks for each artist, so everyone could stay safely distanced from each other. Some of the children participants drew Easter bunnies and Easter eggs and wrote, "Don't forget to smile." Other artists drew hearts and flowers.