COVID-19 Palliative Care Symptom Management Tool Kit for aged residential care

 

Introduction

The following Tool Kit contains resources and Information that may be helpful when caring for those who have developed symptoms of COVID-19 and are residing in Aged Residential Care facilities (ARC).

The symptoms of COVID-19 include a fever of at least 38°C, cough and shortness of breath. The symptoms are similar to other illnesses that are much more common, such as colds and flu. It can then rapidly progress to severe illness, including pneumonia and respiratory failure (WHO, 2020).

Older adults and adults with chronic illness (such as COPD, heart failure) are at particular risk. International experience indicates that the older person with COVID-19 can deteriorate quickly and they are the population group most likely to die from COVID-19 (WHO, 2020, www.covid19.govt.nz). They may die from COVID-19, or be dying from other causes while infected with COVID-19.

Please refer to the latest information accessible via:

This information is changing daily.

Palliative Care Tool Kit

Quality palliative care is a basic human right.

Key care requirements:


Resident Goals of Care:
It is important that services working with elderly, frail, or terminally ill residents be prepared and know in advance the goals of care for each of their residents. Residents and family and whānau need to be fully involved in these discussions.  Discussions need to identify those residents who do not want active life prolonging intervention.  Discussions also need to include communication around possible ICUs declining admission even for some residents who would choose to have active treatment. Below is a link to conversations that may help identify Goals of Care.


Advance Care Planning Discussions:
Many residents will have had these discussions already and may have already completed ACPs. It is essential that these are reviewed and kept up to date, and that outcomes of discussions are clearly documented and included within care plans. All staff and primary care teams need to be aware of these plans and have access to them.


Communication:
Communication is the most important therapeutic intervention at this time. Communication with and between the resident, family and whānau and the health care team (primary care, specialist palliative care team) is key to supporting the resident.


Human Connectedness:
While residents with Covid-19 will be in isolation, promoting human connectedness and communication with their loved ones and significant others will be essential. Significant numbers of residents are unlikely to have physical contact from their families, who may be living out of the region and developing alternative ways of communicating will be essential.

Symptom management including end of life


Physical resources required for caring for residents with COVID-19:


PRN medications for end of life:


Dyspnoea:


Respiratory Tract Secretions:


Pain:


Restlessness and Agitation:


Last Days of Life:
It is expected that older people who have been positively identified as having COVID-19 may deteriorate quickly. Identifying last days of life may be difficult. As with anyone who is recognised as entering their last days this is an interdisciplinary decision and communication with the lead health provider GP/NP, nurses and family and Whānau is essential.


After Death Care and other Resources:
Most residents will remain within their facility and a dedicated supportive environment for those who are dying is essential.
Caring for those who have died with COVID-19 remains the same as those who die from non-infectious diseases. The deceased person does not need specific after death care requirements such as special infectious diseases precautions (water proof bagging).


Bereavement care:
Isolation protocols, and social and emotional isolation from family and friends will have an impact on bereavement support. Connecting with spiritual support workers via virtual medium such as zoom, messenger, skype, telephone etc will help with connectedness.