COVID-19 and End-of-Life Planning
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COVID-19 has hit the United States far harder than any other country. Nearly each week sees the nation’s infection and death totals reach a grave, new milestone. The pandemic serves as a regular reminder that conversations about medical care and end-of-life arrangements cannot wait — no matter how uncomfortable they might make us.
How Has COVID-19 Affected Seniors?
The Centers for Medicare and Medicaid Services (CMS) has only reported on COVID-19’s impact through the middle of May. On June 22nd, CMS revealed that more than 300,000 Medicare beneficiaries were hospitalized for COVID-19 treatment prior to May 16th. The report also uncovered massive disparities in how the disease has impacted (and continues to impact) low-income and minority communities versus others.
This “snapshot” inspired CMS Administrator Seema Varma to release a statement and confirm the organization’s commitment to value-based care. “Now more than ever,” she stated, “it is clear that our fee-for-service model is insufficient for the most vulnerable Americans because it limits payment to what goes on inside a doctor’s office.” With COVID-19 ravaging these vulnerable populations, “The transition to a value-based system has never been more urgent.”
Discussions around subjects like ventilators and resuscitation have necessarily grown more urgent, too. Dr. Sunita Puri, the Keck Medical Center’s director of palliative care, reminds Americans that “things can change in a minute” as the result of a medical emergency. This isn’t just stressful for patients and their families, but for medical professionals as well. Dr. Puri notes that she’s seen careful planning make a huge difference by guiding medical teams and helping family members navigate high-stress situations with as much certainty as possible.
One way for seniors to plan ahead is to outline their wishes for end-of-life care and potentially life-saving treatments in an advance directive. Prior to the pandemic, just 62% of Americans had drawn up one of these documents. Some providers have reported, however, that interest in advance directives has increased considerably over the last six months.
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While advance directives vary from state to state, their purpose is always the same. They empower certain “healthcare agents” to act on a patient’s behalf if that patient becomes incapacitated. More specifically, they identify which procedures a patient does or does not consent too. An advance directive may, for example, include a do-not-resuscitate order or provide instructions for tissue and organ donation.
Dr. Trevor Bibler, an authority on medical ethics and health policy with Baylor University, advises seniors to think of their advance directives as more than just a set of instructions. “Add[ing] additional narrative elements,” he says, can provide a better sense of the patient’s values and help make a decision that would suit their wishes. Rather than relying on checkboxes alone, patients should attempt to communicate a sense of what they consider worthwhile and what they would consider a suitable standard of living.
Patients should not wait until a medical emergency occurs to let their selected healthcare agents find out about the new role. Instead, they should schedule time to have a frank conversation about their wishes and the vital part the healthcare agent will play in acting on them. Again, it may help to focus these conversations on life rather than death.
Updating Your Advance Directive
It’s possible that some seniors avoid signing advance directives because the documents seem off-puttingly final. The American Bar Association notes that advance directives are, in fact, living documents that should evolve with time. As a rule of thumb, they suggest that seniors should review and update their advance directives (at least) every time they experience one of the 5 Ds:
- A new decade in age
- The death of a spouse
- A divorce
- A serious medical diagnosis
- A significant decline in health
Taking the time to review your wishes and have a few unpleasant conversations can dramatically reduce both the financial and emotional impact of a medical emergency or prolonged illness. A COVID-19 vaccine is on the way, but we can’t prevent every unexpected medical event or cure every debilitating condition. Are you and your family prepared for a worst case scenario?