Abstract
Objectives
The COVID-19 pandemic has greatly affected the morbidity and mortality of residents in long-term care (LTC) homes. However, not much is known about its impact on staff’s perception of capacity to provide palliative and end-of-life (EOL) care for LTC residents over the course of the pandemic. We investigated changes in self-reported confidence among LTC workers and their experience in providing palliative and EOL care to residents before and during the COVID-19 pandemic.
Design
Mixed-methods evaluation using surveys (n=19) and semi-structured interviews (n=28).
Setting and Participants
Frontline workers from 9 LTC homes who participated in Communication at End-of-Life Program in Ontario, Canada, between August 2019 and March 2020.
Methods
The survey captured LTC staff’s confidence level, including attitudes towards death and dying; relationships with residents and families; and participation in palliative and EOL care. The interviews identified facilitators and barriers to providing palliative and EOL care during the pandemic.
Results
The COVID-19 pandemic negatively impacted frontline LTC staff’s confidence in their role as palliative care providers. Participants also reported notable challenges to providing resident-centered palliative and EOL care. Specifically, visitation restriction has led to increased loneliness and isolation of residents and impeded staff’s ability to build supportive relationships with families. Furthermore, staffing shortages due to the single-site work restriction and illness increased workload. Psychological stress caused by a fear of COVID-19 infection and transmission also hindered staff’s capacity to provide good palliative and EOL care.
Conclusions and Implications
Frontline LTC staff—even those who felt competent in their knowledge and skills in providing palliative and EOL care after receiving training—reported notable difficulties in providing resident-centered palliative and EOL care during the COVID-19 pandemic.
Key words: palliative care, long-term care, COVID-19, survey, personal narrative, patient-centered care
Footnotes
Fundingsources: This study was supported by the Government of Ontario through the Ontario Centres for Learning, Research, and Innovation in Long-Term Care at Bruyère.
Author contributions: AHS and AM contributed to data acquisition, analysis and interpretation, as well as manuscript writing. EF, AF, AK and ZO contributed to the acquisition of funding, study design, data acquisition and critical revisions of the manuscript. ATH was responsible for the study design, and contributed to the analysis, interpretation, as well as manuscript writing. All authors approved the final version to be published and agreed to be accountable for all aspects of the work.
Declaration of conflicting interests: The authors have no conflicts of interest to declare.
Brief summary: Frontline staff in long-term care homes in Ontario, Canada have been negatively impacted by the COVID-19 pandemic in their role to providing resident-centred palliative and end-of-life care. Notable challenges impeding their confidence and competency in care delivery include: visitation restriction, staffing shortage, and psychological stress.