Families with a loved one in hospice are having to choose one person to be a visitor, who then must stay onsite and sleep in the same room.
Mercy Hospice Auckland has locked its gates on College Hill, and designated "onsite visitors" are asked not to leave, even to take a walk around the block. If they choose to go, another person can't take their place.
The extraordinary restrictions are to protect staff and patients from Covid-19, and will make an already emotional time for families even tougher.
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Some other hospices have stopped taking patients, but Mercy Hospice's chief executive Paul Couper said his team decided to do everything possible to keep their 13 inpatient beds available.
"We are allowing one family member or support person to stay onsite, for the entire length of time. They can walk around our grounds outside, but they can't leave and then come back. They need to stay on our secure grounds.
"The biggest impact is on other family members, and there are some tragic and heart-wrenching stories of people wanting to visit relatives who might be in the hospice. And it is a difficult call - we have not been able to allow that to happen, for the good of all of our staff and the patients."
The onsite visitors are fed and have access to shower and laundry facilities, and support for video or other online contact with wider family. Most of the inpatient rooms already have another bed that can be rolled out.
The visiting restrictions and the impact on families had added to an already stressful time for staff, Couper said. However, the families he had spoken with were appreciative the hospice remained open and for the care received.
Vulnerable patients might be in the hospice for only a few days, with the average length of stay about 10 to 12 days. Other patients stay for months, and some return home.
Mercy Hospice is funded through the Auckland DHB and charitable donations, and takes referrals including from GPs, families and rest homes. Its family support teams and nurses make around 10,000 house calls every year.
Couper said the organisation had struggled to get enough personal protective equipment (PPE). The situation was reaching a point of crisis last week before some gear was finally supplied, but there remained uncertainty about an ongoing and timely supply.
In the past week Director-General of Health Dr Ashley Bloomfield announced facemasks would be supplied to DHBs to give to essential workers in areas like home care, after unions and others raised concerns about the lack of protection available.
Families face further restrictions if their loved one dies during lockdown. Funeral services were banned under the level 4 restrictions, even for close family. That led to situations including a school teacher unable to say goodbye to her mother before her cremation - until the Ministry of Health granted her an exemption on humanitarian grounds, and following Herald enquiries.
On Monday the ministry announced new guidelines, allowing a limited number of family members within the same social-distancing "bubble" as the deceased to visit them in the funeral home. Full services will have to wait until after the lockdown ends.
"As much as we are absolutely behind the Government's restrictions and we understand what they are for, it does mean that families are going to suffer," said Gary Taylor, president of the Funeral Directors' Association.
Hospitals have also introduced strict visiting policies, including for new parents. While most hospitals and birthing centres are allowing a support person to stay with a woman during labour, many have implemented no-visitor policies.