Almost half of the COVID-19 deaths in Europe from the start of the pandemic until January 2021 occurred in nursing homes (1). In Norway, the majority of COVID-19 deaths in 2020 were in the over-80s, and many of these people died in nursing homes (2). Norwegian nursing home residents have an average age of 84 years, a high burden of disease, and 8 out of 10 have dementia (3, 4). These factors increase their vulnerability to a serious clinical course of COVID-19. Early in the pandemic, it was decided that nursing home residents had to be protected through measures such as restrictions on visits from relatives, testing regimes and isolation of suspected cases (5).
The COVID-19 pandemic led to changes in procedures and the workload of healthcare staff in nursing homes. New routines and guidelines were introduced in a short space of time and required rapid reorganisation. At the start of the pandemic, there were particular challenges related to a lack of staff, personal protective equipment and testing capacity (5). There were also large differences between the nursing homes in terms of the numbers of COVID-19 patients. Some had dealt with large outbreaks and many deaths, while others had not (5).
The Norwegian Coronavirus Commission's report concluded that, despite the heavy burden, nursing homes received too little attention during the pandemic compared to the specialist healthcare service (6). Studies from various countries show that healthcare staff who worked during the pandemic, both in nursing homes and other areas of the healthcare sector, experienced various ethical and prioritisation dilemmas (7–9).
The aim of this article was to describe the ethical challenges experienced by nursing home doctors during the COVID-19 pandemic in Bergen and the assessments they made. This is important to gain a better understanding of the measures taken during the pandemic and may provide useful knowledge about preparedness in case of future disease outbreak.