# The COVID-19 experience and the necropolitical space of end-of-life care in residential care facilities in Quebec: A case study

## TL;DR

This study explores how a special care team helped provide end-of-life care in residential care facilities during the pandemic, reshaping spaces and care practices for older adults.

## Contribution

The study introduces the concept of a necropolitical space in end-of-life care during a crisis, highlighting spatial and societal transformations.

## Key findings

- The IHCT initiative transformed RCFs into spaces for compassionate end-of-life care during the pandemic.
- The study identified ambiguities in care spaces and the importance of medication management in this context.
- The model revealed societal hierarchies in valuing the lives and deaths of frail older adults.

## Abstract

The COVID-19 pandemic highlighted the need for innovative approaches to healthcare delivery, particularly for older adults with frailty in crowded settings. In Québec, Canada, the shortage of hospital beds during the pandemic exposed critical gaps in the capacity to provide appropriate end-of-life care for affected residents of residential care facilities (RCFs).

This study aimed to examine the implementation of the COVID-19 Intensive Home Care Team (IHCT) and how it transformed the physical and social environment of RCFs to enable end-of-life care and “dying at home” in an unprecedented time.

A qualitative case study design was used. Between September 2020 and January 2021, qualitative data were collected through 30 in-depth interviews with front-line workers of the IHCT, healthcare managers, and academics in the home care sector. Thematic analysis reveals three interrelated themes: the ambiguities of caring spaces, the centrality of medication management, and the reconfiguration of RCFs through new spatial, technological, and relational arrangements that enabled “dying at home” during the COVID-19 pandemic.

Findings revealed that the IHCT initiative reshaped RCFs into a necropolitical space, showing the complex interplay between space, care practices, and societal values toward older adults with frailty. The transformation enabled a form of compassionate end-of-life care within familiar settings as well as exposed underlying societal hierarchies that determine whose lives, and deaths, are valued.

The IHCT model illustrates how emergency health interventions can reconfigure care spaces and challenge conventional boundaries between home, private, and public care systems. However, it also underscores the ethical and political dimensions of care for frail older adults in crisis contexts.