AUTHOR=Bradshaw Andy , Ostler Sophia , Goodman Claire , Batkovskyte Izabele , Ellis-Smith Clare , Tunnard India , Bone Anna E. , Barclay Stephen , Vernon Martin , Higginson Irene J. , Evans Catherine J. , Sleeman Katherine E. 

TITLE=Provision of palliative and end-of-life care in UK care homes during the COVID-19 pandemic: A mixed methods observational study with implications for policy

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1058736

DOI=10.3389/fpubh.2023.1058736

ISSN=2296-2565

ABSTRACT=Introduction: Little consideration has been given to how the provision of palliative and end-of-life care in care homes was affected by COVID-19. Study aims were: (i) to investigate the response of UK care homes in meeting the rapidly increasing need for palliative and end-of-life care during the COVID-19 pandemic; and (ii) propose policy recommendations for strengthening the provision of palliative and end-of-life care within care homes.

Materials and methods: A mixed methods observational study incorporating (i) an online cross-sectional survey of UK care homes, and (ii) qualitative interviews with care home practitioners. Participants for the survey were recruited between April-September 2021. Survey participants indicating availability to participate in an interview were recruited using a purposive sampling approach between June-October 2021. Data were integrated through analytic triangulation in which we sought areas of convergence, divergence, and complementarity.

Results: There were 107 responses to the survey and 27 interviews. We found that (i) relationship-centred care is crucial to high-quality palliative and end-of-life care within care homes but was disrupted during the pandemic; (ii) care homes’ ability to maintain high-quality relationship-centred care required key ‘pillars’ being in place: integration with external healthcare systems, digital inclusion, and a supported workforce. Inequities within the care home sector meant that in some services these pillars were compromised, and relationship-centred care suffered; (iii) the provision of relationship-centred care was undermined by care home staff feeling that their efforts and expertise in delivering palliative and end-of-life care often went unrecognised/undervalued.  

Conclusion: Relationship-centred care is a key component of high-quality palliative and end-of-life care in care homes but was disrupted during the COVID-19 pandemic. We identify key policy priorities to equip care homes with the resources, capacity, and expertise needed to deliver palliative and end-of-life care: (i) integration within health and social care systems, (ii) digital inclusivity, (iii) workforce development, (iv) support for care home managers, and (v) addressing (dis)parities of esteem. These policy recommendations inform, extend, and align with policies and initiatives within the UK and internationally.