Virus vs. Visitors – Why long-term care needs a palliative approach
As a long-term care clinician and a medical director, I worry about COVID-19. I am responsible for mitigating the risks of COVID-19 and other outbreaks but I am also keenly aware of the dangers of prolonged isolation on residents’ well-being.
While I struggled with the dilemma of virus versus visitors, as a palliative care practitioner, I know the importance of family and friends to overall health.
COVID-19 has exposed the ills of long-term care but I hear words like facilities, beds and dollars when I hear talk about solutions. What we need to hear are words like people, time and quality of life. And we need to talk about a palliative approach to long-term care because the very words symbolize the quality of life we all seek.
We call it long-term care but for those living there it is their home, or it should be. Throughout society, what we have failed to face is that it is often a person’s last home. A long-term care resident is most often elderly and fast approaching the end of life, with an average time from admission to death of less than two years (CIHI 2018).
This is not the time for heroic measures and unnecessary trips to hospitals that often fail to extend life and instead cause more suffering and complications. It is a time to focus on living as well as possible until the end of life, based on an individual’s values and needs. That’s what the palliative approach means. It is not a resignation or a giving-in to death; instead, it is embracing life and all that we are – physically, emotionally, socially, psychologically and spiritually. And it is not just a checklist of tasks – toileting, bathing, feeding and medications – instead it focuses on quality of life.
Intrinsic to both home and quality of life are human connections. Emphatically, in long-term care, those social connections very much include the people most ever-present in a resident’s daily life – the staff. To deliver genuine compassionate and resident-centred care, staff need a few things. For nurses and personal support workers (PSW), limiting work to one home can bring job stability and a personal sense of security and – importantly – allows the staff to get to know the residents and develop those human connections.
Everyone working in long-term care – physicians, nurses, PSWs, allied health providers, administrative staff and volunteers – need to understand the importance of quality of life and deliver it with a palliative approach to care. Fortunately, that approach can be learned. There are excellent training opportunities available, including an online course through Hospice Palliative Care Ontario.
Finally, staff need sufficient time. Quality of life care is not a checklist of tasks completed by a schedule within prescribed hours. Staff need time to genuinely check-in with residents and their families to ensure that physical needs are being addressed while the core values of the whole person are supported.
So, while we work to fix long-term care and talk about systems, standards and bed counts, I strongly urge everyone to remember that we are talking about people – people for whom long-term care is their home, and likely their last home. We all need and want a good home and a good quality of life. Both of these will be realized by familiarizing ourselves and getting comfortable with the palliative approach.