Planning for End-of-Life Care During a Pandemic

Green Settlements Staff

Table of Contents:

  1. COVID-19’s Impact on Seniors
  2. Advance Directives
  3. Keep Planning Ahead

Arrangements for end-of-life care are never an easy thing to discuss, but COVID-19 has made proactivity on the subject especially important. In an interview with NPR, Sunita Pari reminds seniors that, “things can change in a minute.” That’s doubly true while a virulent pandemic continues to sicken and kill Americans in every state. Pari, The Keck Medical Center’s director of palliative care, suggests that careful planning can greatly reduce the strain, stress, and financial impact of an unexpected diagnosis.

COVID-19’s Impact on Seniors

Seniors are particularly vulnerable to COVID-19 infection and are more likely to experience severe symptoms. Early data from the Centers for Medicare and Medicaid Services shows that more than 300,000 seniors were hospitalized for COVID-19 treatment before the end of May. Months later, those numbers have undoubtedly continued to rise.

As of 2017, just under a third of Americans had taken control of their healthcare with advance directives. They were not even especially popular among seniors. A study published in Health Affairs found that fewer than half of Americans over 65 had taken steps to plan for end-of-life care and potentially life-saving treatment. COVID-19’s outsized impact has already inspired many seniors to give these legal documents another thought. Some providers are reporting an exponential increase in inquiries and new business since the pandemic began.

Advance Directives

Planning for a worst case medical scenario — like sudden incapacitation or long-term treatment for a debilitating disease — reduces uncertainty for both patients and medical providers. Advance directives not only speak on the patient’s behalf, but also enable doctors to ethically and effectively administer care. Without such a guide, both family members and providers may struggle with additional stress as they attempt to discern what’s best for a patient.

Seniors can begin to plan for the unexpected by filling out an advanced directive form. These documents (which vary from state to state) help patients indicate what types of procedures they do and do not consent to. For example, a do-not-resuscitate (DNR) order is a common feature of some advance directives.

It’s important to think of advanced directives as much more than series of checkboxes. Trevor Bibler, an expert in medical ethics and health policy, encourages seniors to supplement their medical wishes with “additional narrative elements.” He provides an example, “If I can never interact with my grandchildren again, I would rather be made comfortable.” A statement like this helps providers gain a better sense of what a patient values and what they would consider to be a suitable quality of life.

While filling out an advance directive, take care to name several healthcare agents. These individuals will formally make medical decisions on your behalf in the event that you become incapictated. It’s important to have several backup surrogates under even the best of circumstances. With some entire households succumbing to COVID-19, it’s particularly crucial now.

Patients shouldn’t let appointed healthcare agents find out by surprise. They should schedule time to speak with their surrogates about their medical wishes and the role they’ll play in the event of a medical emergency. It may help to avoid certain grim subjects. Rather than speaking in terms of resuscitation and intubation, patients might talk about what they believe makes life worth living and, alternatively, what they could not stand to lose.

Keep Planning Ahead

Remember that advance directives are intended to be living documents. One common misconception is that they are final, solidifying a patient’s medical wishes for the rest of their life. In fact, the American Bar Association encourages seniors to update them regularly. They encourage seniors to adopt the “five D” plan and update their medical wishes after certain life events:

  • Reaching a new decade in age.
  • Experiencing the death of a spouse or other loved one.
  • Getting divorced.
  • Being diagnosed with a serious medical condition.
  • Suffering a significant decline in health.

You don’t have to wait for one of these events to occur to fill out an advanced directive in the first place. Are you prepared for the unexpected?

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