Were Clinical Routines for Good End-of-Life Care Maintained in Hospitals and Nursing Homes During the First Three Months of the Outbreak of COVID-19? A National Register Study

Abstract

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

“…Of the included studies, four were qualitative, 24–27 three used a mixed method design 15,28,29 and two were quantitative. 14,30 The studies included populations from nine countries, including the UK ( N = 3), 15,25,26 Sweden ( N = 2), 14,30 Ireland ( N = 2), 15,28 Spain ( N = 1), 24 Italy ( N = 1), 24 Mexico ( N = 1), 24 Peru ( N = 1), 24 Pakistan ( N = 1) 27 and the USA ( N = 1) 29 (Table 2). Participants in five studies consisted of care home staff, which included registered nurses, home managers and non-registered staff such as care assistants and domiciliary staff.…”

“…14 Other studies suggest that it may be because of decreased clinical routines and visits from external service staff such as General Practitioners and specialist palliative care teams. 25,30 Lastly, particularly towards the beginning of the pandemic, care home staff's fear of being infected or infecting residents with COVID-19 may have prevented regular care planning discussions. 26,27 Reductions in advance care planning discussions seem to have most significantly impacted residents living with dementia, who are often reliant on relatives and surrogate decision makers.…”

“…A common theme running through the studies regardless of country was the increased responsibilities and expectations of care home staff delivering end of life care during the pandemic. 15,[24][25][26]30 Care home staff were found to be taking on care responsibilities usually delivered by trained clinicians within primary care, 25 and specialist palliative care teams. 30 For example, it was found some managers in the UK were asked to verify residents' deaths without appropriate training or support.…”

“…15,[24][25][26]30 Care home staff were found to be taking on care responsibilities usually delivered by trained clinicians within primary care, 25 and specialist palliative care teams. 30 For example, it was found some managers in the UK were asked to verify residents' deaths without appropriate training or support. Furthermore, in the UK during the first lockdown some managers were making decisions as to whether to admit residents with COVID-19 to the care home.…”

“…15 It was evident that many of these increased responsibilities and expectations were due to poor communication, demand and access restrictions impacting on external services usually involved in supporting residents' end of life care in care homes. 24,25,30 For example, Martinsson et al 30 found that as a result of the restrictions in Sweden, fewer residents were examined by a physician during the last days of their life, and pain management as well as oral health were assessed less frequently, and consultations with specialist palliative care teams reduced. Similarly, a study which collected data from four countries in Europe and Latin America also highlighted instances where care home staff expressed feelings of abandonment by external services and government organisations.…”