Andrea Iaboni (Dept. of Psychiatry, University of Toronto and Toronto Rehabilitation Institute, University Health Network)

Decision-making during a pandemic is fraught with many difficulties. This is particularly true in long term care where COVID-19 has hit the hardest, and where staff and residents are shouldering the burden of infection control.  Uncertainty about the ethically correct course of action, or an inability to pursue this action can create substantial moral distress in healthcare workers.  There is a need to foster and support moral resilience in people working in long term care and one way to do this is to provide ethical guidance and support with decision-making.

The Dementia Isolation Toolkit Working Group is made up of clinicians and researchers based in Toronto, Canada with experience working in long term care.  They are working to develop a series of tools focused on supporting healthcare workers in long term care to care for residents with cognitive impairment or dementia in the context of the pandemic. 

The first tool has just been released: Ethical guidance for people who work in long-term care:  What is the right thing to do in a pandemic?  This is an ethical guidance tool to help healthcare workers think through ethically complex situations, with a focus on the need for quarantine and isolation.  The tool has been written in plain English to improve its accessibility to all healthcare workers.  It has been designed to be as practical as possible by including two worksheets to help people apply the principles in the document.  The first worksheet is designed to help guide the development of a person-centred isolation care plan for someone with dementia.  The second worksheet is a decision-making tool to help people work through an ethical decision-making process.  It is hoped that this tool will support the resilience of people working in long term care; to provide them with the ethical guidance needed for them to continue to act with courage to support each other and their residents through the difficult months ahead. 

The tool can be found at this link:  https://bit.ly/dementiatoolkit