#COVID19 has shown us that #LTC requires urgent reform. This must also include improving provision of #palliativecare. Here’s why (THREAD):

1/DEFINITIONS. “21st century” palliative care is not just end-of-life care. Rather it is an approach to care which addresses suffering early on in the disease trajectory. For most in LTC, the palliative approach to care can be provided by teams, not just specialists.

2/ WHY IN LTC? The average length of stay in LTC is 2 years, and most people remain there until end-of-life. Residents often have inadequate symptom management & frequent hospital transfer. About 1/5 LTC residents are hospitalized for “palliative care.”

3/ GOALS OF CARE. Goals & preferences related to end of life care are often not discussed between healthcare providers, patients and families. Advance care planning may often be confused with consent. This often leads to unnecessary treatments, and death in hospital.

4/ A PALLIATIVE CARE APPROACH IS NOT AGEISM. Most people in LTC are frail and weak. Many would not survive an ICU stay. “Normal” medical treatments often don’t work in many elders or those who are dying, and may even cause harm or worsened suffering.

5/ STAFFING ISSUES. Why does a hospice have 1 nurse for 5 patients, yet LTC has 1 nurse for ~30 patients in the day and ~ 60 at night? Care in LTC, including palliative care is highly specialized- it’s time for the system to recognize & support this.

6/ HOSPITAL TRANSFER. Well known harms include delirium, infection, deconditioning & malnutrition. We could prevent many transfers from LTC for predictable complications such as infections or exacerbations of life-limiting illness by improving care in place.

7/ SYSTEM CHANGE IS NEEDED. The population is aging, and LTC homes should be equipped to handle the dying process for almost all residents. We need to allow seniors to age in place, and re-frame LTCs as “long-term palliative care units.” (END)