More than half of the elderly victims of Covid-19 in Sweden died in nursing homes. Some healthcare workers believe that an institutional reluctance to admit patients to the hospital costs lives.
Lili Perspolisi’s father, Reza Sedghi, was not seen by a doctor on the day of his death from the coronavirus, in his care home in north Stockholm.
A nurse told him that he had received an injection of morphine in the hours before his death, but that he had not received oxygen and that staff had not called an ambulance. “No one was there and he died alone,” said Perspolisi. ” It’s so unfair. “
Most of the 3,698 coronavirus deaths in Sweden to date have been over the age of 70, although the country has declared the protection of at-risk groups its top priority.
Sweden, with 10 million inhabitants, has maintained a larger part of the open society than is the case in most European countries.
“We have failed to protect the most vulnerable, the oldest, despite our best intentions,” Prime Minister Stefan Löfven admitted last week.
- Lockdown, what lockdown? Unusual response from Sweden
- Does Sweden really have its coronavirus science?
Sweden banned visits to nursing homes on March 31. However, as in many European countries, relatives, staff and union officials were concerned that protective clothing had arrived too late and that some staff had been able to go to work at the start of the crisis despite the symptoms of Covid-19.
Now, an increasing number of workers are also showing up to criticize regional health authorities for protocols that they say discourage nursing home workers from sending residents to hospital and prevent nursing homes and the Nursing personnel administer oxygen without the approval of a physician, either in the context of intensive care. or palliative services (end of life).
“We were told not to send them”
“They told us that we shouldn’t send anyone to the hospital, even if they are 65 and have many years to live. We were told not to send them, ”says Latifa Löfvenberg, a nurse who worked in several nursing homes. around Gävle, north of Stockholm, at the start of the pandemic.
“Some may still have many years to live with their loved ones, but they are not lucky … because they never go to the hospital,” she said. “They are suffocating to death. And it’s a lot of panic and it’s very difficult to just sit by and watch. “
Löfvenberg currently works in a Covid-19 ward at a large hospital in the Swedish capital, where she says the demographics of the patients she treats are further evidence that the elderly are being kept out. “We don’t have many elderly people. There are a lot of young people born in the 90s, 80s and 70s ”.
A paramedic working in Stockholm, who wanted to remain anonymous, told the BBC that she had had no calls to an elderly care home connected to Covid-19, despite overtime during the crisis.
Mikael Fjällid, a private Swedish anesthesia and intensive care consultant, says he thinks “a lot of lives” could have been saved if more patients had been able to access hospital treatment, or if nursing home workers had been with increased responsibility for administering oxygen themselves, rather than waiting for specialist response teams or Covid-19 paramedics.
“If you need care and can get it [from] care, for example, or oxygen for a short time, you should have it. Like any other age group in the population, “he says.
“If you have more than 20% surviving without anything, you can assume that perhaps also the same amount or the same proportion would have survived with additional oxygen. “
Decisions on health care staff and resources are made at regional level in Sweden, although national guidelines suggest that elderly patients, whether in public or private care homes, should not automatically be hospitalized for treatment.
Dr. Thomas Linden, Chief Physician at the National Council for Health and Welfare, said workers should “professionally weigh the potential benefits” against risk factors such as catching the virus in the hospital and the “costs” of patient transportation, including the likelihood of disorientation and discomfort.
Health care workers are urged not to discriminate on the basis of age alone, he said, although biological age may be relevant in combination with other factors.
When it comes to providing palliative care, it’s not mandatory to give oxygen to patients, and Dr. Linden admits that “opinions on the value of oxygen are divided between specialties and regions ”.
Gävleborg, the region where Latifa Löfvenberg worked at the start of the pandemic, says that the needs of each patient are always a priority and that nurses can call doctors to assess the need for hospital care.
This goes against the idea that nursing home workers administer oxygen during palliative care, as it requires specialized training.
Christoffer Bernsköld, spokesperson for geriatric care in the Stockholm region, insists that there are enough resources to ensure that patients in the capital receive acute or palliative care, with a focus on ” specialized home care units’ providing help in the first place.
He points to a new unused field military hospital in southern Stockholm as evidence that the elderly are not prevented from getting treatment due to the lack of beds.
But he says it can be an “ethical dilemma” whether to administer oxygen or to transfer patients to the hospital.
Critics like Mikael Fjällid see this field hospital as a sign that officials in the capital have been cautious about the hospitalization of the elderly, as they fear overloading the resources that would be needed to cope with a future spike in case.
How do other countries prioritize patients?
Sweden is not alone in asking health workers to take patients’ frailty into account when deciding whether or not to send them to hospital.
But representatives of nursing homes in other parts of Europe told the BBC that they do not share the concerns of Swedish critics about the lack of access to treatment.
In the UK, the National Care Association says it believes care is available to Covid-19 patients “regardless of age or illness.”
The German Aid Association for the Elderly and Disabled says that every patient with symptoms of coronavirus is seen by a doctor and that no patient has received the care they needed. In some cases, entire nursing homes have been transferred to hospitals. Many homes also keep emergency oxygen on site.
The Danish Nurses Association reports that all patients requiring oxygen are currently being sent to the hospital. This could be revised in the event of a shortage of fans, although age does not affect future guidelines.
More funding and permanent jobs
Swedish Prime Minister Stefan Löfven told the BBC at a recent press conference that regional authorities have confidence to ensure that health care “works the best way” and that it has received additional government resources to cover costs associated with Covid-19.
Last week, the government also announced an additional 2.2 billion crowns (£ 185 million) for additional training in nursing homes to create 10,000 permanent posts for licensed practical nurses and social workers.
Löfven said it was not the right time to think about potential failures but that a national commission would examine how things had been handled at local, regional and national levels as soon as the “acute” phase of the crisis would be over. .
It’s a bittersweet message to relatives of Covid-19 victims like Lili Perspolisi, who buried her father last week.
“Everything they did didn’t work, because … many, many people at his house died,” she said.
Additional reporting by Sira Thierij.