Abstract
COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has a devastating impact on older adults, especially those who live in nursing home facilities. Palliative care, a medical specialty which addresses suffering induced by serious illness, is a potentially powerful tool for managing the devastating effects of COVID-19 in this population. Yet, the crisis amplified existing barriers to palliative care in nursing homes, as well as created novel barriers to this type of care. This study reports the results of exploratory, qualitative interviews with six Directors of Nursing (DONs) in Massachusetts nursing home facilities. Overall, we found that facilitators of palliative care include knowledge diffusion from outside providers, in-house staff certified in palliative care/hospice, and high-quality advance care planning conversations. We also report that many residents signed do-not-hospitalize orders and opted to receive in-house palliative care rather than being hospitalized for symptoms of COVID-19 or other serious illnesses during this crisis. Finally, a lack of personal staff knowledge around palliative care, a lack of PPE, insufficient guidelines from regulatory agencies, facility lockdowns, and patient isolation acted as barriers to palliative care during this time. Future work should focus on improving in-house staff’s ability to deliver palliative care without relying on outside providers. This will likely decrease the time residents wait to receive palliative care, lower hospitalization rates, and make in-house staff more prepared for future crises which require facility lockdowns