I’m a DON in a nursing facility that experienced a lot of COVID-19 cases and deaths due to the virus, both in the facility and at the hospital. We have seen families react so differently when they experience this loss in the hospital vs. in the nursing home. What can we do to help residents and families make their best decisions regarding end of life?
There are a few definite resident caregiving tips in this regard. First of all, start goals of care conversations early. Advance directives should come up:
• On admission (family and resident should be present, and a clergy member, if the resident wants one)
• At care conferences, with family
• At the start of an outbreak (families and residents often change their mind, so revisit their desires)
• Again, with symptoms or positive tests or any changes in condition
Some main talking points on this topic:
• COVID can be lethal for elderly clients and for those with multiple diseases or comorbidities.
• Your facility has and will continue to offer robust symptom management as well as palliative care.
• If a resident develops acute respiratory failure, experience and studies have shown that it is highly unlikely they will recover even with hospital transfer and ventilation.
• Transfer to the hospital will put a frail elder at further risk of trauma, exposure to diseases and interventions that will be unlikely to help.
• Comfort care in a familiar setting by staff who know the resident’s history and personality is the kindest, most humane way to ensure dignity at the end of life.
• Ensure that RESUSCITATION and TRANSFER PREFERENCE information is clearly marked and accessible for ALL HEALTHCARE WORKERS.