End of life care and COVID-19 Pandemic

Elderly woman lying in bed, wearing pajamas, focus is on face, eyes closed

The impact of the current pandemic on our daily lives is undeniable. Social interventions used to contain the COVID-19 pandemic are significantly impacting the way people die. It is affecting how we provide the care for persons who live in aged care facilities including palliative care and end of life care.

We all are experiencing changes in our lives and loses. Some have lost jobs, income, others have lost freedom, future plans and routine. Some may have experienced grief due to losing their love one. As any loss or change can cause grief, we may experience a mild level of grief while we have been involved in these loses (Harris 2020).

Grief is a natural and inevitable reaction to lose; however, our social context has an important role in how to manage loss and grief. Social support plays a strong role to achieve positive outcomes after bereavement (Volkan and Zintl 2018; Currer 2017). It has its own challenges during this pandemic as people need to consider the physical restrictions.

Physical restriction means limited or no physical contact or visit to aged care facilities. These restrictions could affect the dying person’s wishes about their care and limits family members to comfort the dying person. Those family members may experience feeling of regret over missing opportunity to be close to their love one in their final moment (Wallace et al. 2020). Therefore, it is important for the care providers such as aged care facilities to ensure the provided quality palliative care meets the dying person’s and their family’s expectations.

Advanced Care Planning plays an important role in this pandemic time. Advanced Care Planning is a guide that person can develop to express their end of life wishes and what is important to them when they are critically ill (Curtis et al. 2020).  Increasing communication based care planning is also a key strategy to address possible grief among critically ill person and their families (Shore et al. 2016). Family meetings can take place over the phone to ensure Advance Care Planning meets the dying person’s needs and family expectations. Registered Nurses who work in aged care sector need to increase their communications with family members of dying persons and ensure their dying person’s end of life wishes are fulfilled. Considering the physical restriction during the pandemic, the way family members can be connected to their dying person has also changed. Facilities may use alternative ways such as mobile phones, electronic tablets, and watching video messages to ensure families are connected to their love ones (Ingravallo 2020).   

Although those alternative measures should be available to support family members of a dying person, family members may still have exacerbated feeing of grief as a result of physical isolation. Therefore, family members of dying persons should be provided opportunities for cognitive and emotional support for accepting death. By doing this, they may have better bereavement months after losing their love one. Other ways of supporting such as telephoning, texting or expressing condolences via social media, cards or mails can be helpful.


Currer C. Responding to grief: Dying, bereavement and social care. Macmillan International Higher Education; 2017 Mar 14.

Curtis JR, Kross EK, Stapleton RD. The importance of addressing advance care planning and decisions about do-not-resuscitate orders during novel coronavirus 2019 (COVID-19). Journal of the American Medical Association 2020. doi: 10.1001/jama.2020.4894. [ePub ahead of print]

Harris DL. Non-death loss and grief: Context and clinical implications. New York: Routledge, 2020.

Ingravallo F. Death in the era of the COVID-19 pandemic. Lancet Public Health 2020;5(5):e258. doi: 10.1016/S2468-2667(20)30079-7.

Shore JC, Gelber MW, Koch LM, Sower E. Anticipatory grief: an evidence-based approach. Journal of Hospice Palliative Nurse 2016; 18:15e19.

Volkan VD, Zintl E. Life after loss: The lessons of grief. Routledge; 2018 Mar 29.

Wallace CL, Wladkowski SP, Gibson A, White P. Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers [published online ahead of print, 2020 Apr 13]. Journal of Pain Symptom Management. 2020; S0885-3924(20)30207-4. doi:10.1016/j.jpainsymman.2020.04.012

Dr. Mozhdeh Tahghighi is a Clinical Nurse Manager in Aegis Aged Care Group and has a PhD in Psychology, Master of Nursing Science.

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