Confined, resigned, the elderly in nursing and care homes went through all the emotions: sadness, anger, distress, only to realize that it is the law of the day for everyone. Again, the staff are afraid. Here too, the world has stopped, but between four walls: the residents are confined to their rooms. There are no more common activities.
Some men are spared from COVID-19. Others have not had this chance and are struggling with sick patients, sometimes sent to the intensive care unit, sometimes not … According to what?
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Recently, a directive of the Belgian Society of Gerontology and Geriatrics has aroused a lot of legitimate emotion. She recommended ne no longer hospitalize and send elderly patients infected and very weakened by the coronavirus back to their nursing homes.
Fierce or not?
The College of General Francophone Medicine gives clear guidelines. It all depends on whether the patient and his family previously established, outside of the crisis, an advance planning of care by discussing the desirability of a relentless therapeutic end of life.
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This planning, if it exists, will be the first decision criterion. This is the reason why a private nursing home that we have contacted will send an email to the families of its residents, asking them the very sensitive question of keeping alive at all costs in case of COVID-19 in a member of their family who would no longer be able to pronounce themselves.
According to the directives of the College of General Medicine, this is “to seek everyone’s intimate desire regarding, at least, the need for hospitalization and / or resuscitation in the event of COVID-19 injury by explaining the possibility of providing comfort and palliative care within the institution.“
Inform and anticipate care
A suspected resident of COVID-19 will first be informed if he or she is able to understand the situation, as well as their loved ones. The first step will be to anticipate the possible worsening of the patient’s respiratory state.
For residents for whom an advance decision to refuse hospitalization or resuscitation is known and updated, who present risk factors of severe form or other signs of clinical seriousness, nursing and care homes are called upon to anticipate a possible aggravation, by providing palliative care: ready-to-use oxygen, adequate drugs and protective equipment for carers. These drugs are mainly morphine and benzodiazepines.
An ethical decision support grid is used to guide staff, depending on whether or not the patient and their family have made a prior resuscitation decision in the event of cardiopulmonary arrest.
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