Ethical considerations relating to long-term residential care facilities

On Thursday 28 May the National Public Health Emergency Team (NPHET) approved the guidance document entitled “Ethical Considerations Relating to Long-Term Residential Care Facilities in the Context of COVID-19“.

The purpose of this paper is to give ethical guidance for the provision of person-centred, rights-based care to people living in long-term residential care settings (LTRCS) during the COVID-19 pandemic. LTRCS encompass a broad group of services, including community hospitals, nursing homes, and residential facilities for people with intellectual disabilities or mental health difficulties, as well as a variety of providers. However, given that the most significant burden of COVID-19 has been placed on older persons, in particular on those living in LTRCS, issues discussed are particularly pertinent to nursing homes.

Individuals in LTRC settings have the same human rights as other people and must be treated with dignity and respect. Decision-making involving people with intellectual disabilities or diminished capacity must promote inclusion, autonomy and participation to the greatest extent possible. The provision of health and social care during a pandemic should continue to be person-centred and follow a rights-based approach.

While each individual has their own specific care needs and care settings differ, the paper highlights ethical considerations associated with congregated settings, such as increased vulnerability to infection and onward transmission within the residential community, difficulties with communication, testing and the implementation of physical distancing, the impact of isolation and restricted contact with family and loved ones, and the proportionate protection of rights.