Combating Coronavirus Disease-2019 Outbreak in Long-Term Care Facilities for Frail Older Adults: Preventive Measures and Palliative Care Go Hand-in-Hand

2021 ◽  
pp. 082585972110393
Author(s):  
Hon Wai Benjamin Cheng
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Care Delivery ◽  
Nursing Home Residents ◽  
Respiratory Illness ◽  
Term Care ◽  
The People ◽  
Care Facilities ◽  
Novel Coronavirus

While the whole population is at risk from infection with the coronavirus, older people—often frail and subject to multimorbidity—are at the highest risk for the severe and fatal disease. Despite strict infection control and social distancing measures, frail adults in long-term care facilities may be at particular risk of transmission of respiratory illness. Treatment decisions are often complex attributed to the heterogeneity of this population with regards to different geriatric domains such as functional status, comorbidity, and poly-pharmacy. While measures must be taken to prevent the novel coronavirus from spreading through these facilities, it is also essential that residents with coronavirus disease 2019 (COVID-19) have access to the symptom management and support they want and deserve. What most nursing home residents want during the course of their illness is to be able to stay in their facilities, to be surrounded by the people they love most, and to feel relief from their physical and emotional pain. By addressing the limited access to hospice and palliative care delivery in nursing homes, we can prevent unnecessary suffering and pain from COVID-19 as well as lay the groundwork for improving care for all residents moving forward.

scholarly journals Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review

2020 ◽  
Vol 34 (5) ◽  
pp. 558-570 ◽  
Author(s):  
Danni Collingridge Moore ◽  
Sheila Payne ◽  
Lieve Van den Block ◽  
Julie Ling ◽  
Katherine Froggatt ◽  
...  
Keyword(s):  
Palliative Care ◽  
Scoping Review ◽  
Long Term Care ◽  
Care Delivery ◽  
Implementation Strategies ◽  
Term Care ◽  
Care Facilities ◽  
Study Characteristics ◽  
Implementation Stages

Background: The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Interventions to improve palliative care delivery within these settings have been shown to be effective in improving care, but little is known about their implementation. Aim: The aim of this study was to describe the nature of implementation strategies and to identify facilitators and/or barriers to implementing palliative care interventions in long-term care facilities. Design: Scoping review with a thematic synthesis, following the ENTREQ guidelines. Data sources: Published literature was identified from electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL. Controlled, non-controlled and qualitative studies and evaluations of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were sourced and data extracted on the study characteristics, the implementation of the intervention, and facilitators and/or barriers to implementation. Results: The review identified 8902 abstracts, from which 61 studies were included in the review. A matrix of implementation was developed with four implementation strategies (facilitation, education/training, internal engagement and external engagement) and three implementation stages (conditions to introduce the intervention, embedding the intervention within day-to-day practice and sustaining ongoing change). Conclusion: Incorporating an implementation strategy into the development and delivery of an intervention is integral in embedding change in practice. The review has shown that the four implementation strategies identified varied considerably across interventions; however, similar facilitators and barriers were encountered across the studies identified. Further research is needed to understand the extent to which different implementation strategies can facilitate the uptake of palliative care interventions in long-term care facilities.

scholarly journals Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalia Arias-Casais ◽  
Eduardo Garralda ◽  
Miguel Antonio Sánchez-Cárdenas ◽  
John Y. Rhee ◽  
Carlos Centeno
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Long Term Care ◽  
Task Force ◽  
National Level ◽  
Structured Interviews ◽  
Term Care ◽  
Care Facilities ◽  
Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

The vulnerability of nursing home residents to the Covid-19 pandemic

2020 ◽  
Vol 23 (2-3) ◽  
pp. 57-60 ◽  
Author(s):  
Edward H Wagner
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Nursing Assistants ◽  
Nursing Home Care ◽  
Term Care ◽  
Staff Members ◽  
Care Facilities

Residents in nursing homes and other long-term care facilities comprise a large percentage of the deaths from Covid 19. Is this inevitable or are there problems with NHs and their care that increase the susceptibility of their residents. The first U.S. cluster of cases involved the residents, staff, and visitors of a Seattle-area nursing home. Study of this cluster suggested that infected staff members were transmitting the disease to residents. The quality of nursing home care has long been a concern and attributed to chronic underfunding and resulting understaffing. Most NH care is delivered by minimally trained nursing assistants whose low pay and limited benefits compel them to work in multiple long-term care settings, increasing their risk of infection, and work while ill. More comparative studies of highly infected long-term care facilities with those organizations that were able to better protect their residents are urgently needed. Early evidence suggests that understaffing of registered nurses may increase the risk of larger outbreaks.

scholarly journals Advancing Palliative Care in Long Term Care Facilities (LTCFs) in Europe Within the PACE Project: An Innovative Educational and Development Intervention

2018 ◽  
Vol 56 (6) ◽  
pp. e70-e71
Author(s):  
Sheila Payne ◽  
Katherine Froggatt ◽  
Jo Hockley ◽  
Danni Collingridge Moore ◽  
Lieve van den Block
Keyword(s):  
Palliative Care ◽  
Long Term Care ◽  
Term Care ◽  
Development Intervention ◽  
Care Facilities

Palliative care provision in long-term care facilities differs across Europe: Results of a cross-sectional study in six European countries (PACE)

2019 ◽  
Vol 33 (9) ◽  
pp. 1176-1188 ◽  
Author(s):  
Maud ten Koppel ◽  
Bregje D Onwuteaka-Philipsen ◽  
Lieve Van den Block ◽  
Luc Deliens ◽  
Giovanni Gambassi ◽  
...  
Keyword(s):  
Palliative Care ◽  
Advance Care Planning ◽  
Long Term Care ◽  
Care Planning ◽  
Care Provision ◽  
Cross Sectional ◽  
Term Care ◽  
Care Facilities ◽  
Advance Care

Background: While the need for palliative care in long-term care facilities is growing, it is unknown whether palliative care in this setting is sufficiently developed. Aim: To describe and compare in six European countries palliative care provision in long-term care facilities and to assess associations between patient, facility and advance care planning factors and receipt and timing of palliative care. Design: Cross-sectional after-death survey regarding care provided to long-term care residents in Belgium, England, Finland, Italy, the Netherlands and Poland. Generalized estimating equations were used for analyses. Setting/participants: Nurses or care assistants who are most involved in care for the resident. Results: We included 1298 residents in 300 facilities, of whom a majority received palliative care in most countries (England: 72.6%–Belgium: 77.9%), except in Poland (14.0%) and Italy (32.1%). Palliative care typically started within 2 weeks before death and was often provided by the treating physician (England: 75%–the Netherlands: 98.8%). A palliative care specialist was frequently involved in Belgium and Poland (57.1% and 86.7%). Residents with cancer, dementia or a contact person in their record more often received palliative care, and it started earlier for residents with whom the nurse had spoken about treatments or the preferred course of care at the end of life. Conclusion: The late initiation of palliative care (especially when advance care planning is lacking) and palliative care for residents without cancer, dementia or closely involved relatives deserve attention in all countries. Diversity in palliative care organization might be related to different levels of its development.

scholarly journals CLINICAL AUDIT: QUALITY OF PALLIATIVE CARE IN LONG TERM-CARE FACILITIES IN WESTERN FRANCE, 2015

2017 ◽  
Vol 1 (suppl_1) ◽  
pp. 547-547
Author(s):  
J. Prudhomm ◽  
V. Morin-Chouarbi ◽  
M. Bechac ◽  
E. Menand ◽  
A. Corvol ◽  
...  
Keyword(s):  
Palliative Care ◽  
Audit Quality ◽  
Long Term Care ◽  
Clinical Audit ◽  
Term Care ◽  
Care Facilities

What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review

2011 ◽  
Vol 26 (5) ◽  
pp. 722-733 ◽  
Author(s):  
Gwenda Albers ◽  
Richard Harding ◽  
H Roeline W Pasman ◽  
Bregje D Onwuteaka-Philipsen ◽  
Sue Hall ◽  
...  
Keyword(s):  
Systematic Review ◽  
Palliative Care ◽  
Long Term Care ◽  
Term Care ◽  
Care Research ◽  
Care Facilities

scholarly journals Building a Palliative Care Consult Service in Long-Term Care Facilities: Strategy, Business Model, And Outcomes (S704)

2013 ◽  
Vol 45 (2) ◽  
pp. 418 ◽  
Author(s):  
Teresa Albanese ◽  
Steven Radwany ◽  
Erica Hoiles ◽  
Christine Hudak ◽  
Kelly McGranahan
Keyword(s):  
Palliative Care ◽  
Business Model ◽  
Long Term Care ◽  
Consult Service ◽  
Term Care ◽  
Care Facilities

Caring About Residents’ Experiences and Symptoms (CARES) Program: A Model of Palliative Care Consultation in the Nursing Home

2016 ◽  
Vol 34 (5) ◽  
pp. 466-469 ◽  
Author(s):  
Deborah A. Morris ◽  
Marissa Galicia-Castillo
Keyword(s):  
Palliative Care ◽  
Nursing Home ◽  
Long Term Care ◽  
Descriptive Analysis ◽  
Nursing Home Residents ◽  
Term Care ◽  
Code Status ◽  
Care Plans ◽  
Palliative Care Consultation

Objectives: To describe the CARES program, a model of palliative care for nursing home residents. Design: Descriptive analysis of the Caring About Residents’ Experiences and Symptoms (CARES) Program that provides palliative care services to nursing home residents. Program evaluation: The CARES Program serves as an example of collaborative efforts to meet community needs. To evaluate the program, we document the services provided as well as process outcomes (changes to care plans, hospitalizations, location of death, and hospice utilization) for residents referred. Results: 170 nursing home residents were seen by CARES Program between February 2013 to December 2015, 48% for skilled services, and 52% for long term care. Majority of referrals were for goals of care and concurrent symptom management. Following consultation, 67% of residents had a change in code status. Of residents desiring a palliative course 90% were never hospitalized. Overall, 53% of residents died; and those in long term care dying more often with hospice. Conclusion: The CARES program of palliative consultation addresses the needs of nursing home residents. The model has potential to be reproducible in in other communities.

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