| Never has there been a greater need for hospice care than during the deadly pandemic that has killed more than half a million Americans. But Covid-19 has disrupted almost every aspect of comforting the terminally ill at the end. Even as vaccinations roll out across the country, the system remains under unprecedented strain. As infection rates and hospitalizations plateau and, in some regions, rise after months of improvements, pressures on hospice care are unlikely to ease anytime soon. "We're preparing for another wave," said Melinda Gruber, president of the Caring Circle hospice provider in Michigan, where Covid hospitalizations are climbing again. Hospice organizations are struggling to retain staff as workers, many of them women, stay home to shield their families from infection or to school housebound children. Families of some patients find they get little more than drugs and instructions from providers hesitant to let workers spend more than a few minutes inside someone else's home.  Source: Chinnapong/Getty Images Source: Chinnapong/Getty Images Workers making visits day after day often find they can't provide the personal care essential to their mission. Holding a patient's hand isn't the same through a glove, even when that's possible. Some hospice organizations have banned hugging grieving relatives, the kind of small-but-human act at the job's heart. "I just don't feel like I'm doing hospice nursing," said Kathy Chludzinski, who works in the Seattle area. "I just can't be a hospice nurse, it seems, in this time." Chludzinski, a 25-year veteran, must now care for many patients over the phone and keep in-person visits under 10 minutes. Covid makes being present to ease a patient's and family's transition to death almost impossible, and hospice providers in her area are scraping for staff. Unemployed people aren't rushing to fill the physically and emotionally draining jobs. Some positions pay well, but less-skilled home health aides, who often lift and wash patients, and change bedding and diapers, can make as little as $9 an hour. "Amazon can pay better,'' said Edo Banach, chief executive officer of the National Hospice and Palliative Care Organization. "If you can get paid more per hour for delivering a box than for really intensive, hands-on care, it's a challenge keeping people.'' Hospice providers have tight budgets in the best of times, many of them operating as nonprofits reliant on donations. The work is decidedly unglamorous. Yet it is also a profoundly essential service. "Hospice organizations struggle with staffing ordinarily, because there aren't enough nurses and physicians and physical therapists to go around,'' Banach said. "Then you throw on top a pandemic."—David R. Baker and Dina Bass | 
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