Advance Directives—The COVID Factor

COVID-19 has brought a new sense of urgency to advance care planning. “Since the beginning of the pandemic, we’ve been trying to get in front of this difficult situation by having honest discussions with our clients and their family members,” said Jill Titze, Lifesprk Nurse Practitioner. “Many seniors who test positive for the disease do recover with manageable symptoms, but those who become severely ill most often decline very quickly.” If there’s no Advance Directive, neither the family nor the hospital know the client’s end-of-life wishes.

The question of hospitalization

The question Jill and her Lifesprk colleagues ask clients to really think about is, If I get COVID, do I want to be hospitalized? The decision to be hospitalized has taken on new meaning since coronavirus. “The trend we’ve seen with the geriatric population, particularly during the April and November surges, is that when people go to the hospital, it’s highly likely they won’t leave,” said Jill. Due to COVID restrictions, they will be alone at the end of life.

For clients with complex medical conditions—advanced dementia, heart failure, vascular disease, kidney disease—the decision not to hospitalize is an easier discussion. “Families want to be with their loved one at the end,” said Jill. “We can actively treat COVID patients at the facility with steroids, oxygen, and antibiotics; if the client still declines, we can then shift our focus to keeping them as comfortable as possible.” Jill added that at her facility, when a client is nearing end of life, family members are allowed to be at their bedside, provided they have been screened for COVID and wear masks and face shields.

For clients who are more independent, the discussion can be trickier. “I have a background in intensive care, so I can explain the medical realities associated with ICU and lengthy hospital stays,” said Jill. “The truth is whether you’re admitted for COVID, pneumonia, stroke, heart attack, or hip fracture, if you do get discharged, you’re going to leave at a lower functional level.” Post-pneumonia recovery, for example, can take weeks or even months due to scarring of the lungs.

Bridging the communications gap

Older adults who’ve been in and out of the hospital are well aware of this, but family dynamics can complicate their decisions. “Clients will tell me, ‘I don’t want to go to the hospital, but I’m afraid my daughter will have a really hard time if I die.’” Jill works to bridge the communications gap between adult children and their loved ones, often talking with families as much or more than with clients. “Before the pandemic, when I was able to meet with the family face-to-face, it was easier to lay the groundwork for hearing their parent’s end-of-life wishes,” said Jill. “It’s a bit harder now, but we’re getting used to having these conversations over Zoom or on the phone.”

Ultimately, it’s not about whether or not a client wants to be put on a ventilator, Jill said, but what they consider a good quality of life. “Is your priority to stay independent? Spend time with family? Be able to walk? Live as long as possible, no matter what? These are important questions to ask yourself,” she said. “The deadly nature of this virus has changed our reality, making the pandemic the perfect time to revisit your goals and wishes for the rest of your life.”

Take control of your future

Lifesprk is passionate about helping you stay in control of your life’s most important decisions—and that includes your end-of-life wishes. Get started today with Lifesprk’s free eBook, Creating Your Advanced Directive eBook. Need immediate support? Reach out to our team 24/7 and schedule a free consultation.