Borja Arrue
Project and Policy Officer responsible for long-term care
AGE Platform Europe
In a previous post, we pointed to the discriminatory practices in hospitalization that we were observing in the first wave of the COVID-19 pandemic. Ever since there has been mounting evidence confirming exclusion from hospitals on the sole basis of age. Older people were often rejected and sometimes even when free hospital beds and places in intensive care were still available. On Human Rights Day, we need to talk about this true human catastrophe happening in front of our eyes. Are we actually learning the lesson?
An almost systematic exclusion from hospital care
Doctors Without Borders (MSF) intervened in care homes in Belgium during the first wave and delivered over the summer a shocking account of their observations. They pointed to lack of staff, lack of protective equipment and a true de-prioritisation of older people using care home services:
“there was limited possibility to refer residents to external medical services, in particular to hospitals. Before the crisis this possibility was at 86%, which dropped to 57% during the crisis. In the care homes that our teams visited, just over 70% had received a positive response to all their calls to emergency services (112). Visits from general practitioners (GPs), were down by half from the pre-crisis period, which had a huge impact on the medical treatment of residents, not only for COVID-19 symptoms but for other health issues”.
Similar situations have been observed and reported in other countries, in other settings and by other organisations. Overall, the instructions given by some governments and service managers seem to have included prioritization of patients on the sole basis of age. Other considerations such as the overall health status, the likeliness of survival or the personal preferences were largely ignored. And so even in situations where hospitals still had the capacity to take care of those patients.
The gaps in palliative care: dying alone
The pandemic has revealed and aggravated long-standing gaps in care for older people. Sadly, few of the elements reported by organisations such as MSF are truly surprising for older people in need of care, informal carers, professionals or those of us working for the rights of those in need of care and support.
The same applies to access to palliative care. Whereas it is probably too early to draw well-documented conclusions, we know COVID-19 is happening in a context of insufficient access. We need to look at the thousands of deaths from COVID-19 and remember that many of them (most?) lacked access to quality palliative care to realise the dimension of this human tragedy.
Worse, the pandemic has added a new challenge to pre-existent shortages in palliative care: additional staff shortages and the no-visitors policy. As the MSF report highlights, many older people in care homes died alone, without the company and support of their loved ones and sometimes also without professionals around. The psycho-social dimension of palliative and end-of-life care, as well as the usual rituals surrounding end-of-life, have been largely absent. It is at the same time easy and impossible to imagine the suffering of those in such situations and the feelings of guilt and powerlessness that many care professionals have been reporting.
A turning point?
Are things going any better in the second wave? The greater availability of personal protective equipment and testing has made it possible for countries to make lockdown measures more flexible than in the first wave. However, deeply rooted problems regarding both discriminatory practices in hospital admission and shortages in palliative care are unlikely to have substantially improved over such a short period of time.
But are governments and us all learning the lessons and finally beginning to put the basis of care systems based on the principles of dignity and equality? Will we finally ensure everyone in need can enjoy the benefits of palliative and end-of-life care?
Some studies are hopeful this may be the case. That COVID-19 may be contributing to increase the awareness of the shortages of care systems and accelerate long-needed reforms and additional investments. Only time will tell. On Human Rights Day, let’s remember the dignity of all of us depends on well-funded, quality, accessible care and support services we all need throughout our lives. The human tragedies we have witnessed should not have happened and should not happen again in the future.