Healthcare personnel trained in Palliative Care (PC) is scarce, so it is essential to use the available resources to reach the largest number of patients who need it. One of the challenges in the COVID-19 context is to provide primary PC (by generalists, nurses, disease specific specialists, etc. with basic CP training.) at the patient's home / residence.
Primary PC at home is indicated for the relief of symptoms or the care at the end of life of non-ventilated COVID-19 patients who would not benefit from hospitalization, or when it is not available or accessible.
It can be considered if:
1. The patient is stable enough to receive care at home.
2. There are caregivers who monitor the patient's evolution and recognize the signs and symptoms of any worsening of his / her situation.
3. Caregivers have personal protective equipment (minimum: gloves and masks) and have the capacity to: perform 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 be without sharing an immediate space with others. It is best to have a bathroom for his / her exclusive use, but if it is not possible (a) use the bathroom only to carry out needs and bath, (b) limit the stay in it to a minimum, (c) enter with a mask, (d) carry out a correct hand washing when incoming and leaving, (e) wait 30 minutes after it was used, (f) each person must bring their items to be used (toilet paper roll, towel, soap, etc.), (g) maintain the hygiene of the bathroom and 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 adults and 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 (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 indicate the administration of emergency medications. Then they will guide the administration of medications by phone, chat or video.
Medications and emergency items can be provided in a box, and should only be used if the PC team doctor or nurse instructs the caregiver 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