No greater misfortune than nursing home residents dying alone

As Canadians agonize about their loved ones in nursing homes dying of COVID-19 alone and in pain, we must act now to prevent further undignified deaths. With hundreds of Canadian homes under outbreak, and resident deaths accounting for more than half of all Canadian COVID-19 deaths, international news headlines have gone so far as to label nursing homes “death pits.”

Nursing homes are in desperate need of palliative medications and guidance on the delivery of comfort-based care and terminal sedation. They also need increased COVID-19 testing capacity and a mandate to communicate to families and the public the number of COVID-19 cases and deaths within their home.

Emerging mobile specialty teams with expertise in palliative care need to be rapidly upscaled and marshalled across the country. With our acute care system still well below capacity, we need our hospitals to look after residents when nursing homes become overwhelmed and their personal protective equipment supply depleted.

Finally, we must consider handing operational control to the government for nursing homes unable to provide adequate care to their residents as has been done in provinces like British Columbia.

Tragically, many dying nursing home residents are not receiving any end-of-life care, and most are dying alone as a result of restrictive visitation policies.

In Canada, 31 nursing home residents in Dorval were left to die — when authorities arrived, residents were either found dead in their beds or on their last breaths strewn across the floor, severely dehydrated and covered in daysold feces and urine.

The situation is dire, especially since one-in-three COVID-19 infections among nursing home residents is fatal. There is a critical shortage of health care workers in nursing homes, with many workers having fallen ill or being appropriately restricted to working at one home, which has further reduced capacity.

Low staffing ratios are so extreme that even basic care is an impossibility, let alone the provision of intense end of life care. There are also shortages in medications like opioids — used to relieve pain and breathlessness at the end-of-life — as the critically low supply is being shunted to acute care hospitals for patients on mechanical ventilators who require sedation.

For months, health-care systems have intentionally focused efforts on building capacity in the acute care sector to prepare for the potential surge of critically ill COVID-19 patients seen in countries like China and Italy. At the same time, little to no attention was given to expanding and allocating scarce palliative care resources for those individuals who wouldn’t have access to critical care, including the majority of Canada’s nearly 200,000 nursing home residents.

As the second wave of the COVID-19 epidemic rips through Canada’s nursing homes, we must take immediate action to ensure we support dying residents when they need it most.