Annette Bauer and Josie Dixon (Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science)

The full report is available here:

• Palliative care has a vital role to play in the response to COVID-19, for relieving pain and other symptoms associated with the condition, particularly breathlessness; for providing emotional and spiritual support; and to ensure dignity in dying.
• There is evidence from media reports that some older people, who died in care homes during the pandemic, did so without adequate basic care, including palliative care. However, the proportion of people of those who died, or continue to die, in care homes with insufficient palliative care is unknown.
• In this paper, we summarise some of the challenges experienced in North America, Europe and Australia during the COVID-19 pandemic with regards to palliative care provision in care homes. We consider these in the context of long-standing challenges with systems of palliative care provision and care home services, highlighting opportunities for change.
• Most countries have focused measures in care homes on the prevention or control of Covid-19 infection rather than on the provision of palliative care, with most care homes poorly-prepared and positioned to provide effective palliative care to their residents.
• Most countries have developed various guidance documents for health and social care staff on palliative care. However, in many countries, guidance is not setting-specific. It is also often patchy in its coverage or inconsistent, and details about how to operationalise recommendations is commonly lacking.
• Lack of personal protective equipment for staff and visitors and shortages of palliative care medications have been major barriers to ensuring effective palliative care and a good quality of death for care home residents.
• The COVID-19 crisis has exposed the weaknesses of many health and social care systems, including the underfunding and understaffing of care homes and palliative care provision. There were already calls in most countries, prior to the current crisis, to scale measures that ensure high quality palliative care in care home settings. Once the acute phase of this crisis has passed, countries should revisit these recommendations, which include training curricula for care home staff that include palliative care; quality standards for palliative care in care homes; national monitoring of quality standards and indicators; national minimum data sets that include palliative care in care homes; and clear contractual arrangements between specialist palliative care providers and care homes.