In April, a nurse at a Stockholm home for the elderly told Helen Gluckman that her 83-year-old father would likely not live for long. He had been stricken by COVID-19 and the home recommended putting him on end-of-life care, she said.
Gluckman, 55, said she agreed because she did not want him to suffer pain. Her father, Jan Gluckman, who suffered from dementia, was put on morphine, according to his medical records seen by Reuters. He died a week later.
She said that only after his death did she discover that a doctor had recommended putting her father into palliative care without a bedside examination.
The doctor took the decision after speaking by phone with a nurse at the home, the nurse wrote in the records, even though they showed his breathing and fever had improved by then.
Gluckman now believes his life could have been saved.
“In hindsight, had I known what I knew just a month later, I would have said ‘over my dead body’. It’s so incredibly tragic,” Gluckman said in a telephone interview.
Jan’s medical records, obtained by his daughter and reviewed by Reuters, highlight a broader issue in Sweden, the country which has grabbed global attention during the pandemic for its relatively light lockdown restrictions.
Last week, Sweden’s Health and Social Care Inspectorate (IVO) found “serious shortcomings” in elderly care, saying that in only 6% of cases it reviewed were COVID-19 patients given a physical examination by a doctor.
A fifth received no individual assessment by a doctor at all, the report found. It acknowledged the difficulties of providing healthcare during a pandemic, but said standards were too low nonetheless.
Medical group Familjelakarna, responsible for the doctors tending to the Berga nursing home where Gluckman died, declined to comment on individual cases. It did not respond when asked about administering palliative care to patients without a face-to-face examination by a doctor.
Familjelakarna provides doctor services to some 70 nursing homes in Stockholm.
Sakarias Mardh, chief executive at Ansvar och Omsorg, which operates the Berga home, said it only administers palliative care on doctors’ orders.
Elderly care is the responsibility of Sweden’s 21 regions. The Stockholm Region declined to comment on Gluckman’s case or the situation in the capital more broadly.
Jan first complained about cold symptoms on April 7 and developed a fever four days later, his records show.
When a positive COVID-19 test came back on April 17 his nurse noted that he had eaten very little in the past days, but his fever had subsided and he was breathing without difficulty.
A note from the nurse in the records showed the doctor ordered palliative care later the same day, with a standard end-of-life cocktail including morphine and a sedative.
Jan died at the home in the early hours of April 24. His daughter had been to see him twice during the last week of his life, since visits to the home were allowed in cases where the patient was on palliative care.
Since the start of the pandemic, 23 of Berga’s patients have died from COVID-19, but the nursing home has not had any cases since May, Mardh said.
Sweden’s pandemic strategy, shunning lockdowns and masks, has been closely watched as a possible model on how to avoid the worst of the economic impact that restrictions have caused.
With close to 6,700 deaths from COVID-19, the death rate is many times higher than that of its Nordic neighbours, although it is well below some other countries on a per capita basis.
Nursing home residents account for nearly half of the dead.
“It’s a huge scandal and highly unethical,” said Yngve Gustafson, professor in geriatrics at Umea University, a long-time critic of how Sweden has treated elderly people during the pandemic. He did not comment specifically on Gluckman’s case.
Mardh, of nursing home operator Ansvar och Omsorg, said the IVO report did not reflect well on regional authorities and the providers of doctor services.
“The situation is obviously not good. The report from IVO shows this has not been handled well.”
IVO, which spent months investigating care at nursing homes after a flood of complaints from relatives and staff, stated that not one of the regions had taken sufficient responsibility for the treatment during the pandemic.
“People have not received the individual assessment that they are entitled to by law and the criticism from IVO is very serious,” Prime Minister Stefan Lofven told a news conference last week.
After a relatively calm summer, Sweden is in the midst of a severe second wave that is not expected to peak until mid- December. Deaths have risen sharply once again and the number of infected nursing home patients is now as high as it was in the spring.
“I’m not sure we have learnt anything,” said Helen Gluckman. “Sadly, I have lost confidence in our politicians completely.”