Health care personnel trained in palliative care (PC) are scarce, so it is essential to use available resources to reach the largest number of patients in need. One challenge in the COVID-19 context is to provide primary PC (by generalists, nurses, disease-specific specialists, etc. with basic PC training) at the patient's home or their residence.
Primary PC at home is indicated for the relief of symptoms, or end-of-life care of non-ventilated COVID-19 patients who would not benefit from hospitalization, or when hospitalization is not available or accessible.
It can be considered under the following conditions.
1. The patient is stable enough to receive care at home.
2. There are caregivers to monitor evolution of the patient's condition and who can recognize the signs and symptoms of worsening of their situation.
3. Caregivers have personal protective equipment (minimum: gloves and masks) and have the capacity to: perform proper hand hygiene, take precautions when coughing and sneezing, maintain cleanliness and adequate ventilation of the environment, and limit movement in the home.
4. There is a separate bedroom where the patient can live without sharing the space with others. It is best to have a bathroom for their exclusive use. If that is not possible, then everyone in the home must:
• use the bathroom only to bathe and for other necessities,
• enter with a mask,
• limit their stay to a minimum,
• wash hands correctly upon entering and when leaving
• wait 30 minutes after the bathroom was last used,
• bring their own items being used (toilet paper roll, towel, soap, etc.), and
• maintain the hygiene of the bathroom, cleanse it with bleach at least 2 or 3 times a day, and keep it ventilated.
5. Food and other requirements are available.
6. There are no people with serious chronic conditions (heart or lung disease, diabetes, etc.) in the home at risk of complications from COVID-19 infection.
How can primary PC providers proceed?
-
In non-urgent situations: if they have a 24/7 phone, chat or video line, they can carry out evaluations and therapeutic interventions at regular intervals, at a distance (support for patients and caregivers, dose changes, guidance on hydration/feeding, measures of comfort, etc.).
-
In urgent situations (patient with complex/acute/uncontrolled symptoms, or high risk of death): they should make a home visit, assess the situation, and discuss the administration of emergency medications. Then they will guide the administration of medications by phone, chat, or video.
Medications and emergency items for the patient can be kept in a box, and should only be used if the PC team doctor or nurse instructs the caregiver on how to use them.
See reference for more information. Translated and adapted from Wenk R. Información para personal sanitario. Cuidado paliativo en domicilio para pacientes con COVID-19 no ventilados. 2020. Internet. Available at https://www.fundacionfemeba.org.ar/blog/contenido-simple-3/post/cuidado-paliativo-en-domicilio-para-pacientes-con-covid-19-no-ventilados-48173. Accessed on October 6, 202