Covid 19 epidemic in “Establishments for dependent elderly people”
Press release from the National Academy of Medicine
March 27, 2020
Establishments for dependent elderly people enable doctors and health care providers to carry out their mission in accordance with their duty of humanity.
The rapidity of the health crisis due to Covid 19 has created a disruption in the balance between patient needs and the resources in terms of personnel, products and materials available. The lack of resources is particularly acute in the structures that take care for the elderly and dependent people.
In the institutions that accommodate them, these people suffer from increased isolation. Health-care staff suffers from not being able to face the challenge as lacking of the required conditions of care. For families, the announcement of the death of a loved one is all the more traumatic as it is accompanied by health hygiene measures that violate their fundamental right to recollection.
Faced with this very serious situation, the Academy considers it urgent to provide institutions for the elderly with masks and screening tests for both patients and staff from the very first symptoms.
Visits by accompanying persons should be authorised when the rapid change in the resident’s state of health occurs following a relationship disruption, provided that that the barrier measures are strictly respected.
The Academy calls for the creation of beds in medium-stay/suite care facilities, allowing the transfer of residents tested positive.
The staff in place should also be provided with additional human resources so that they can provide care in accordance with the texts guaranteeing compliance with the informed… consent of the persons and the collegial procedure.
The fate of a life requires a moment’s reflection that cannot be done by one person alone.
The Academy also reminds us that a medical decision cannot depend solely on the reading of prediction scores, whose automatic application would be inhuman, even arbitrary since it varies according to various specialties. Scores provide a useful and necessary insight, but which should not be exclusive except by substituting the coldness of a protocol for the clinical and human analysis of each situation.
With regard to the decision not to transfer to an intensive care facility, the Academy stresses that it must be accompanied by care and support alternatives, with the support of mobile geriatric and palliative care teams and associative actors. A period of religious or spiritual accompaniment must be organized if the patient or his relatives express this wish. A psychological support by a professional may prove to be necessary, in addition to the empathic listening and feelings of humanity that the doctor must demonstrate to the patient and his family.