How covid 19 affects end of life care ? By Ms Diamond South Yorkshire 2020

So while I have been doing my 10 days of facts for my pageant platform ( which is cancer awareness and end of life care) the facts I have been posting are pre pandemic, so I have done some research on how end of life care is affected by covid 19. This information is straight from the NHS.

As we all know there are certain people of the population that are most at risk and at this time it’s those who are elderly, frail, have serious illness or co-morbidities and this is the population supported and managed by End of life professionals every day.

The presence of Covid 19 can make pre existing conditions worse and therefore create a situation where someone may have to discuss end of life care to ensure that they are comfortable and dignified death and supporting families and staff who are looking after them.

The NHS is under a lot of pressure at the moment but end of life care is still incredibly important and they are still acting within national and local guidelines that are in place including having honest conversations with the patient about the goals of the care they are receiving and how the treatment can change or escalate if needed. It is advised that the escalation treatment and end of life support plans should be discussed as early as possible so this can be personalised to each patient and documented.

According to information from the NHS. “All professionals responsibility to provide palliative and end of life care goals to ensure that essential palliative and end of life care is delivered, both for those who are likely to be in their last year of life because of a pre- existing health condition as well as those who may die as a consequence of infection with COVID- 19.

It is important to remember that most people infected with COVID-19 virus have mild disease and recover. Of the laboratory confirmed patients, about:

✅ 80% have had mild to moderate disease

✅ 15% require admission to hospital for severe disease

✅ 5% require admission to an intensive care unit and are critically ill 5

This guidance is aimed at all professionals carers supporting patients with COVID-19, and their families, in the hospital setting – whether this is in critical care or elsewhere in the hospital.”

Throughout the Covid 19 outbreak all hospitals have access to specialist palliative care teams, whether they are in-house Hospital Palliative Care Teams or as in-reach teams from the local palliative care services. These team can then provide additional advice and guidance if needed.

The NHS are making sure staff know that guidelines are already in place for end of life care and should be adhered to.

“They are described in terms of the severity of the disease and adopt the general approach of:

✅ correct the correctable

✅ non-drug approaches

✅ drug approaches

Generally, non-drug approaches are preferred, particularly in mild to moderate disease. Drug approaches may become necessary for severe distressing symptoms, particularly in severe disease.

Typical starting does of drugs are given. However, these may need to be adapted to specific patient circumstances, e.g. frail elderly (use even lower doses of morphine), or renal failure (use an alternative to morphine). Seek appropriate advice from the relevant specialists including specialist palliative care teams.

It is anticipated that critically ill patients with ARDS will be mechanically ventilated and be receiving some level of sedation ± strong opioids. Death may still ensue from overwhelming sepsis or organ failure. If endotracheal extubation is planned in a dying patient, teams should follow their own guidelines on withdrawal of ventilation.”

I have seen that hospitals are either stopping it limiting visits to people in hospital who have tested positive for covid 19. In these cases they might not be able to say goodbye to there loved ones but they are trying to allow more video calls so people can say goodbye.

Another thing that has been effected is funerals. As we all know we have to social distance and stay inside this is to save life’s and incredibly important during this pandemic.

The current Government guidances for funeral services is that they should only be attended by members of the immediate family who are not in any of the high-risk categories and are not self-isolating.

No specific number has been set by the Government. Only the following people should attend:

• members of the person’s household

• close family members

• if the deceased has neither household or family members in attendance, then it is possible for a modest number of friends to attend

Wakes are not possible at the moment so many are waiting until after the pandemic to them have wakes to celebrate the life’s of people who have sadly passed away during the pandemic.

Visiting family and friends in care homes and hospices is not possible at the moment either one care home (Rotherham Hospice) has set up a dedicated email address so family and friends can email there loved ones these are then read out to the person they are for.