End of life Care during COVID-19 in residential care facilities

End of Life Care (EOLC) brings many challenges which are unique and complex (PalliAged 2019), and they worsen if a terminally ill person acquires COVID-19.

EOLC in crisis such as COVID-19 context can be confronting and challenging for not only the resident and their loved ones but for the health professionals involved in their care as well. Often difficult clinical and ethical decisions need to be made. The main aspect of providing effective care is planning ahead.

Deterioration occurs suddenly; therefore, it is vital to have timely discussions around advance care planning to discuss goals of care.
Communication should involve discussing topics such as hospital transfers and what kind of care should be initiated if the resident acquires Covid-19 or deteriorates during a crisis such as COVID-19.

Such discussions are ultimately helpful for staff, particularly new graduates, as they can follow these directives as a guideline.
During COVID-19 decision making may not be easy due to visitors’ restrictions in place. Therefore, timely discussions for residents at risk such as EOLC are imperative with families and carers.

Be prepared to ESCALATE symptom management to prioritise comfort (unmanaged symptoms may add distress to residents, families, and staff) (Palliative Care Australia 2020; The Department of Health 2020).

Another important aspect of effective EOLC is considering the potential limitations for resources affecting COVID19-context. Medication stock is one of the main ones. It is important to have adequate stock, making sure emergency stock or imprest stock is replenished each time medication is borrowed. The existing medications should be checked for their expiry date; and discuss other options such as the use of anticipatory medications (Bowers et al. 2019). It will not only ease the symptoms but will also prevent unnecessary hospital transfers and the stress, panic, and anxiety among staff and families.

Other equipment such as subcut intimas, oxygen cylinders, nasal prongs, or masks should also be readily available. Vital signs may not be observed in EOLC; however, the need to use this equipment may arise to make clinical decisions.

Furthermore, personal protective equipment and cleaning products such as antibacterial wipes are equally important to manage the infectious illness. Complex grief and complex bereavement are likely to be a result of dying during the COVID-19 pandemic. It is necessary to ensure resources are available to support the person, family, and staff (Palliative Care Australia 2020 & The Department of Health 2020).

The key to effective EOLC is using a person-centred approach to provide holistic care with the use of a multidisciplinary team. It is significantly important to define realistic goals of care by shared decision making.


Bowers, B, Ryan, R, Kuhn, I, & Barclay, S. 2019.’Anticipatory prescribing of injectable medications for adults at the end of life in the community: A systematic literature review and narrative synthesis’, Palliative Medicine, vol. 33, no. 2, pp. 160–177.

Palliative Care Australia 2020, COVID-19 Updates, https://palliativecare.org.au/covid-19-updates

PalliAged 2019, Symptoms and medicines, https://www.palliaged.com.au/tabid/4706/Default.aspx

The Department of Health 2020, Palliative Care, https://www.health.gov.au/health-topics/palliative-care

Diva Madan, Nurse Educator-HE (RN, MN clinical education, BN, BSc, DN, DM, Cert IV TAE, Authorised Nurse Immuniser).

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