This guidance provides information and considerations for a person with confirmed COVID-19 infection being cared for at home at the end of life. It should be read in conjunction with Chapter 8 of the
COVID-19 Infection Prevention and Control (IPAC)Manual and the
COVID-19 screening and guidance for NSW Health outpatient and home visiting health services. Please note however that the latter guidance is not specifically about care for people with confirmed COVID-19 infection.
This document will be reviewed and updated when related resources are produced.
It will be highly challenging to care for people with COVID-19 at home, rather than at hospital, and the requirements to minimise risk to people receiving palliative care, carer/family and workers will be significant. Where the considerations in this guidance cannot be met by all care providers, the person may need to be cared for at hospital, even though this may not be the person’s preferred location of care. Palliative care and/or community nursing services may have local tools or processes to facilitate home care, where this is decided upon and can be supported.
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Yes, if a person with a confirmed COVID-19 infection does not require admission to hospital for their care, it is possible for them to be cared for at home, including in a residential aged care facility (RACF). This applies when a COVID-19 positive patient is receiving supportive or palliative care, or care in the terminal phase. In situations and clinical conditions where virtual care may be challenging (e.g. when the person is unstable and the family are not able to provide care), alternative accommodation should be considered, such as a medi-hotel or care in hospital as clinically appropriate.
Consideration for palliative care at home should be made on a case by case basis, and given the infection prevention and control and care considerations it may not be possible for care to be provided in the home. However, where this is in line with patient wishes, and there is capacity to do so, the following guidance and considerations are provided.
Palliative care at home can only be provided when:
The above factors should be considered before referrals for community palliative care are accepted during the pandemic if the referral is in part for a home death. Please note that community palliative care providers vary across LHDs.
Alternative approaches to delivering care, including telehealth, should be considered to support care. The person, their family and carers will be involved in discussions and decisions about care.
Alternative approaches to delivering care, including virtual care, and hospital admission for palliative care should be considered. The person and their carer/family will be involved in discussions and decisions about care. Wherever possible, actions should be taken to support carer/family contact in some form.
When local service plans have capacity to support care at home for people with confirmed COVID-19 with complex clinical needs, people will need to be admitted for care. This may change at times according to people’s current need, local case numbers and service capacity. The PCS may need to make some additional checks to ensure the person and carer/family’s needs can be met.
In sites where providing palliative care at home is an option for care, a holistic assessment will need to be conducted to identify the services and supports required by the person, their carer and family. In this instance, the PCS and other community services required for a home death may also need to make some additional checks to ensure the person’s and their family’s needs can be met.
This may include:
The following guidance should be referred to:
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The PCS should engage with families and careers to make sure that they fully understand the implications of caring for the person at home. The following information should be provided:
NSW Health PD2020_011 contains further information.
Handling of the deceased with COVID-19 by hospital and funeral staff will follow
NSW Health Interim Guidelines.
Please refer to the
CEC videos and information on putting on and removing (‘donning and doffing’) PPE, when caring for patients with some infectious diseases such as COVID-19.
It is important to limit the household members present.
Caregivers and household members should follow the below advice to reduce their risk of infection.
If you are a caregiver or household member and develop
any symptoms of COVID-19 such as a cough, a sore or scratchy throat, shortness of breath, loss of taste, runny nose, loss of smell or a fever (37.5° or higher) you should get tested at a
COVID-19 testing clinic, even if symptoms are mild. If it is a medical emergency, you should call 000. Tell the testing clinic that you are caring for a person with confirmed COVID-19. Use a surgical mask when in the presence of other people, or when attending medical care
Wash your hands often and thoroughly with soap and water for at least 20 seconds. You can use an alcohol-based hand sanitiser if your hands are not visibly dirty. Avoid touching your eyes, nose, and mouth with unwashed hands. Always wash your hands before putting on and after taking off PPE.
Wear a surgical mask, gown, goggles and disposable gloves when you are in the same room as the person with confirmed infection, or when you touch or have contact with the person’s blood, body fluids and/or secretions, such as sweat, saliva, sputum, nasal mucus, vomit, urine, or diarrhoea.
Refer to Chapter 8: Home Visits of the COVID-19 Infection Prevention and Control Manual for guidance on household cleaning and disposal of contaminated items.
Health and Social Policy Branch
Dr Nigel Lyons, Deputy Secretary, Health System Strategy and Planning
28 June 2021
Palliative care professionals and other health care workers supporting people receiving palliative care and their carers and families.