A geriatric and palliative care physician offers nursing homes guidance on getting through the COVID-19 pandemic.
The country desperately needs nursing homes to step up and provide care for a lot of people who will die in the COVID-19 pandemic, according to one geriatric and palliative care physician.
“Nursing homes have no way to avoid outbreaks—they can reduce the risk and increase the likelihood of delay, but it still is a roulette,” writes Dr. Joanne Lynn in her March 28 blog. Indeed, outbreaks are “not the result of inattention in the nursing homes—it’s the combination of the behavior of this virus and congregate living,” she writes.
To meet the challenges facing them, writes Lynn, nursing homes need to know how to:
Identify what nursing home residents would want to happen if they develop a bad case of COVID-19. “This requires that we carry out a substantial number of sensitive discussions quickly—this week, or as soon as possible,” she writes. These resources can help: VITAL Talk, The Conversation Project, and The Social Work Hospice and Palliative Care Network.
Treat a person with respiratory failure: Each nursing home will need ways to get oxygen and morphine, which allows the patient to relax and still to have enough oxygenation to survive and maybe recover. Seek the help of the local hospice or hospices, Lynn advises.
Remove the bodies of residents who have died. “Talk with the major funeral homes and crematoria in the area to be sure that they are staffing up and stocking up, and that they understand the urgency of removing the body promptly,” she writes.
Conduct tests for immunity: Within a few weeks, tests for immunity to coronavirus should begin to become available, predicts Lynn. “If a nursing home can get those tests for its staff, you can tell which of the staff are already immune, and those staff can probably work with COVID-19 patients without risk to themselves.”
Engage in the regional planning process. Nursing homes must be “at the table” when disaster planning is underway.
“I know this is tough stuff,” concludes Lynn. “I know it is hard to say, and harder to implement. But it is the nursing homes, home care, hospices, and assisted living that shortly will become the sites of a great deal of serious illness and death, as the hospitals fill up and overflow. Others in the health care system and the government would do well to help nursing homes to do their generally quite unfamiliar job, since they won’t have the option to opt out.”