Impact of the COVID-19 pandemic on end of life care delivery in care homes: A mixed method systematic review

Abstract

Background: Current evidence suggests that COVID-19 is having a negative impact on the delivery of end of life care in care homes around the world. There is a need to collate current evidence to provide a comprehensive overview to assess extent of the problem. Aim: To describe and evaluate the impact of the COVID-19 pandemic on end of life care delivery in care homes. Design: Systematic review and narrative synthesis of studies reporting qualitative and quantitative data. Data sources: The databases MEDLINE, psycINFO, SCOPUS and CINAHL were searched between December 2019 and March 2021. Results: Nine studies were included. For care home staff, challenges included significant increases in responsibility and exposure to death, both of which have taken an emotional toll. Results indicate that staff tended not to be offered adequate emotional support or afforded the time to grieve. For those receiving end of life care, results indicate that the end of life care that they tended to receive, especially in the form of advance planning, was disrupted by the pandemic. Conclusion: The effect of the pandemic has been to exacerbate existing problems in the provision of end of life care in care homes for both service providers and users, making that which was previously opaque starkly visible. Future research is needed to explore the effects of the pandemic and its management on those receiving end of life care in care homes and their significant others.

COVID-19 deaths in care homes: primary care management study

“…The rates of ‘typical’ COVID-19 symptoms within our cohort were consistent with other studies 8. Other studies have highlighted that ACP discussions were disrupted by the COVID-19 pandemic, particularly when discussions needed to involve family and proxy decision-makers 9. However, our case series highlights issues with pre-existing ACP.…”

Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic

“…18 The COVID-19 pandemic's impact on the provision of PC services has been well described in inpatient and home care settings. 8,[19][20][21][22] However, little is known about PC delivery challenges in the outpatient clinic during this period for in-person and telehealth visits. A few studies documented PC telehealth delivery challenges during the pandemic, but they had small sample sizes and were conducted within a single health system.…”

Managing the Impact of COVID-19 in Nursing Homes and Long-Term Care Facilities: An Update

“…The COVID-19 pandemic has a substantial impact on the provision of appropriate palliative care in nursing home settings and significantly disrupted the provision of appropriate end-of-life care. 145 For instance, in addition to other end-of-life routines not being followed, relatives were only present at time of death in a minority of cases in one study. 146 Additionally, in those dying from COVID-19, fewer discussions were had about end-of-life care in comparison to the year previous.…”