Palliative care in nursing homes in the face of the COVID-19 pandemic (Catalonia, Spain)

Jordi Amblàs-Novellas (Central Catalonia Chronicity Research Group (C3RG) and Xavier Gómez-Batiste (Chair of Palliative Care UVic-UCC)

According to a recently published population-based cohort study, analyzing data from more than 300,000 people in the last 10 years in Catalonia, the typical profile of a person living in geriatric nursing home is an 87-year-old woman, probably with dementia (prevalence 46%), with multimorbidity and complexity (51% of high-risk adjusted morbidity group [AMG]), that is in the last stretch of her life (prevalence of end-of-life situation of 54%, with overall annual mortality around 20-25%). This picture, which is probably similar in many other countries, highlights the need for quality palliative care in these settings. And the current COVID-19 pandemic has made this even more evident.

Faced with the current crisis, the need for specific measures, solid criteria, and key ethical principles is evident in order to guide and support professionals and organizations in this very complex situation. To this end, the research group on chronicity in Central Catalonia (C3RG), the chairs of palliative Care and Bioethics, and the Centre for Social and Health Studies (CESS) at the UVic-UCC (Catalonia, Spain) promoted a consensus of specific recommendations to guide professionals and organizations in the difficult decision-making process as one of the greatest challenges to be addressed.

This consensus was achieved in a record time of 2 weeks at the height of the first wave of the pandemic, with the participation of 12 scientific societies, 5 bioethics entities or their chairpersons, as well as 15 organizations -including professional associations, employers’ associations, research, and administration groups—. There is no precedent in the published literature for a document of this nature, with such a broad consensus and with such a pragmatic and practice-oriented approach, which begins with the individualized assessment of the residents (and their needs and preferences), incorporating the family and the team as key players, as well as an evaluation of the territorial resources and their accessibility and referral criteria.

This crisis has acted as a stress test of the care systems, and we have found that we had areas for improvement for the short, medium and long term. One of these areas is undoubtedly palliative care in nursing homes. It is up to us that we learn the lessons and act accordingly.

Articles referenced in this post:

Amblàs-Novellas, J., Santaeugènia, S.J., Vela, E. et al. What lies beneath: a retrospective, population-based cohort study investigating clinical and resource-use characteristics of institutionalized older people in Catalonia. BMC Geriatr 20, 187 (2020).

Amblàs-Novellas J, Gómez-Batiste X. Recomendaciones éticas y clínicas para la toma de decisiones en el entorno residencial en contexto de la crisis de COVID-19. Med Clin (Barc). 2020;155:356–359.–462-avance-resumen-clinical-ethical-recommendations-for-decision-making-S2387020620304356

Amblàs-Novellas J, Martínez-Gómez R, Blasco-Rovira M. La atención paliativa en las residencias durante la pandemia COVID-19 (o cuando el coronavirus llamó a la puerta del ámbito más vulnerable del sistema). Med Paliat. 2020;27(3):234-241

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