Covid-19 Makes Signing Advanced Directives Critical
Advanced directives are even more critical with COVID-19 patients, who are often elders. The New York Times had a story about an older woman who was suffering from Covid-19 When she entered the hospital no one asked about advanced directives. After several weeks on a ventilator, the hospital asked about advanced directives, she had none. All her elderly sisters could recall was what she had said about dying when she was young.
WHEN DO YOU DISCUSS ADVANCE DIRECTIVES?
Advanced Directives should be part of your initial psychosocial assessment. Once the COVID-19 diagnosis is known with an elderly client, the care manager who has added end of life services to their agency is often the one who will initiate and guide advance care planning discussions. As difficult as these discussions may be, the burden on the family is significantly lessened if decisions about advance care planning are made before the client’s condition worsens.
Hopefully, this has already been done but many people put it off for fear of death. A recent study found that less than 50% of severely or terminally ill patients had an advance directive in their medical record.
Advance Directives
Advance directives are legal documents that allow clients to make decisions about their health care and finances in advance of when they are not mentally or physically able to do so. These documents must be signed, dated, and witnessed naming another person to make decisions for you.
Your job as a care manager is the make sure the dying client has these documents:
• A durable power for an attorney for healthcare
• A do not resuscitate order DNR (efforts to restart the heart after it has stopped
If the client does not have these legal documents and wishes to create
them, the Geriatric Care Manager will suggest that the documents be put in place with the oversight and consultation of an elder law attorney. But if hospitalization is imminent, getting the patient to consider signing with legal consultation maybe your own option, with the family’s permission.
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