Dr. Rita Manfredi, an Associate Professor of Clinical Emergency Medicine, Hospice and Palliative Physician at George Washington University Hospital sits down with Cheddar to discuss the state of hospitals in the DC area, the conversations families and young people need to have, and how we can prepare for the second wave, including how individuals can prepare themselves for any health emergency with an advance care plan with MyDirectives.
In response to The New York Times’ opinion piece: Do Not Resuscitate
Emergency rooms, by definition, are hectic. COVID-19 is pushing these facilities to their limit and beyond. Even if we had all the PPE, ventilators and testing kits needed today, all too often our providers are still flying blind because they do not know the goals of care of the person they’re treating, nor who speaks for them if they cannot speak for themselves.
If every American had an advance care plan – a document, statement or even a video message that accurately answers those two questions – that was immediately accessible in the medical record, doctors and nurses would have at least a fighting chance to honor a patient’s wishes, because they could find them in the first place.
Dr. Na’s plea deserves to be heard. Our health insurers, employers and public officials should step up to help make sure all adults have a plan that is updated and accessible when and if needed.
The consequences of not having an advance care plan are profound. If we ignore people’s wishes because we refuse to ask all Americans to create their own plan, we sow the seeds of mistrust that risks undermining faith in our entire healthcare system’s desire to be truly person-centered.
Jeff Zucker is CEO of ADVault, Inc. and creator of MyDirectives.com, the world’s leading all-digital advance care planning platform.
By Michael Wasserman
While COVID-19 is training its sights on older Americans, far too little is being said or done about the negative impact of current public health policies on this most vulnerable of populations. Meanwhile, those of us who are best equipped to minimize the risk to older Americans — geriatricians like myself — have been largely excluded from the conversation.
My colleagues knew what would happen next when they read about the first case of COVID-19 at the Kirkland nursing home outside Seattle. Geriatricians are trained to care for the most complex patient population there is, and they must often make treatment and management decisions in the absence of extensive data. We knew that Kirkland would be the first of many such stories to come — unless officials moved aggressively.This coverage of the coronavirus pandemic is part of your subscription to The San Diego Union-Tribune. We also provide free coverage as a service to our community.
The New York Times reported late last week that the virus that causes COVID-19 had invaded at least 4,100 American nursing homes and other long-term care facilities. We are seeing unprecedented rates of spread among residents and staff and “pre-symptomatic” coronavirus carriers may be a significant factor.ADVERTISING
This unfolding tragedy is compounded by a lack of decisive state and federal action to protect seniors in these communities. Each state, county, municipality, hospital and senior facility seems to be approaching the problem differently. A lack of a coordinated and resourced response is putting lives at risk. Every day, we see more obituaries for older Americans, and that’s no accident.
Caring for an older COVID-19 patient is complex. It requires medical monitoring, strict infection control guidelines, well-trained staff and available personal protective equipment. It also takes strong institutional management practices and exquisite attention to all aspects of care.
The average senior living community does a good job in normal times, but caring safely for highly infectious patients is a tall order. Staffing levels and competencies vary. Facilities layouts may not support isolation and basic supplies. Operationally, they do not function like hospitals, and they are ill prepared for a pandemic.
All that said, we can still take meaningful action to protect vulnerable older populations. The strategy to do so is straightforward and within reach but will require a national mandate and close statewide and regional coordination.
COVID-19 patients must be grouped together in dedicated spaces to protect other seniors from getting infected. That will help with conserving protective equipment, maintaining enhanced infection control and reducing staff exposure.
Front-line workers in every senior living setting need to wear masks throughout their shift. This will help prevent “pre-symptomatic” employees from spreading the virus to residents and co-workers. Ideally, every resident would also have a mask. If Walmart can equip its employees with masks, we can do the same for older Americans.
Facilities also need to learn to function differently to lessen the impact of COVID-19 infections. This will require education, training and changes in operations at senior living centers, developed and designed by experts in geriatrics and post-acute care.
Among the most important recommendations is one all Americans can do right now: Make an advance care plan of their own. Medical providers can provide the best care when they know both their patients’ goals of care and who speaks for them if they can’t speak for themselves.
Health insurers, employers and government officials should encourage us all to make a plan, keep it updated, share it with family and friends and — most of all — make sure it is easily accessible digitally in a crisis.
Finally, there are precious few geriatricians in federal, state and local government. Generally, those who are there are not in the room as policy decisions are being made. As a result, we have already seen a number of well-meaning decisions that inadvertently put the lives of tens of thousands of Americans at risk.
I am afraid that some in our society have learned the wrong lesson from COVID-19’s toll on older people. They seem to have resigned themselves to unnecessarily high losses — essentially giving up on the generation that fought the wars, built the infrastructure and established the civic virtues that cemented America as the most prosperous country of the 20th century.
Coping with coronavirusThe pandemic sweeping the globe has changed everyone’s lives, and we want to hear how it’s changed yours. If you’d like to write an op-ed for us on a subject related to the virus, make it 700-750 words and send it to us with your name and a phone number so we can reach you.
We can’t let that happen. They deserve better, and we can do better.
Geriatricians like me took an oath and feel a deep responsibility to older Americans. We call our leaders to let us put our experience to work before it’s too late.
Wasserman is a board-certified geriatrician, a certified medical director and president of the California Association of Long Term Care Medicine.
Read Dr. Wasserman’s piece on the San Diego Union-Tribune’s site here.
For Immediate Release: April 16, 2020
For ADVault: Heather Cabral
West End Strategy Team
Dawn Van Dyke
ADVault, Inc. and eHealth Exchange Deliver Advance Care Plans Directly Within Electronic Health Records
Overwhelmed Providers Can Now Find Person-Generated Goals of Care and COVID-19 Statements in Real-time
VIENNA, VA and DALLAS, TX –– eHealth Exchange, one of the nation’s largest health information networks, announced today its newest network participant, ADVault, Inc., the creators of MyDirectives. The MyDirectives platform allows individuals to upload or create, store and share their advance directives, advance care plans and portable medical orders like POLST forms. Now integrated into eHealth Exchange, the ADVault Exchange™ global repository is accessible by any healthcare provider participating in the eHealth Exchange for the patients they treat. This reduces the burden health organizations face in trying to get this critical information directly from patients or their caregivers during times of crisis.
ADVault also announced that personal COVID-19 statements can now be added as a type of advance care planning document that consumers can store for free in the ADVault Exchange. Now, more than 75 percent of all U.S. hospitals, including the USNS Comfort in Los Angeles and USNS Mercy in New York City, have immediate access to advance care plans including, possibly, updated details such as desires to be cared for “in place,” for a ventilator or other specific healthcare wishes.
“During this pandemic, people are frequently alone without an advocate in the room and potentially unable to speak for themselves, and hospitals are resisting paper documents from patients for risk of infection,” explained Scott Brown, co-founder and president of ADVault. “So now it is more critical than ever for people to have confidence our healthcare system cares enough about you to hear your voice, access your goals of care and talk to the people you’ve asked to speak for you. We are honored to work with eHealth Exchange to help more people have such confidence.”
Dallas-based ADVault is a global, person-generated health data company credited with inventing digital advance care planning in 2007. MyDirectives.com and MyDirectives MOBILE allow people to upload paper advance directives (e.g., Caring Conversations®, Five Wishes® and the Veterans Administration’s form 10-0137), digital advance care plans such as MIDEO® and the MyDirectives uADDTM, the new COVID-19 personal statements and portable medical orders such as POLST and MOLST forms. The service is entirely free to consumers. The platform is financially supported by providers and health insurers such as Humana and UnitedHealthcare who want to help their members have a voice in their care.
“Even before the current pandemic, we as a healthcare community understood that advance care plans are imperative to better serve people by understanding their wishes for care,” said Jay Nakashima, executive director of eHealth Exchange. “ADVault’s addition of personal COVID-19 statement functionality is a significant addition to the value that eHealth Exchange is bringing to our healthcare ecosystem. We thank ADVault and its integration partner Zen Healthcare IT for putting this collaboration on the fast-track so our participating hospitals and health information organizations can help more people during this intense global crisis.”
In normal circumstances, providers and caregivers use the eHealth Exchange to access patient information from outside their own facility to ensure a complete clinical picture and to make more informed decisions for better care. Advance care planning documents, including the COVID-19 statements that individuals are recording with their doctors, nurses and loved ones, on file with MyDirectives are now being pulled into electronic health records to empower caregivers with vital information to help guide clinical decision-making.
“Everyone at eHealth Exchange and at Zen moved quickly in recent weeks as the global health crisis caused leaders to realize the growing importance of advance care plans,” said Mike Munoz, ADVault’s director of product. “We are impressed with the entire team’s effort to focus on behalf of consumers and their goals of care.”
About ADVault, Inc.
Since 2007, Dallas, Texas-based ADVault, Inc., is the world’s leading all-digital advance care planning platform via the award-winning MyDirectives and MyDirectives MOBILE interfaces, now with consumer users in over 50 countries. MyDirectives lets people create, store, update and share the free MyDirectives digital advance care plan or upload any third-party advance directive (such as documents from Caring Conversations®, Five Wishes®, the VA Form 10-0137 (U.S. Department of Veterans Affairs), advance care plan, COVID-19 personal statements or portable medical order. Additional information can be found at www.advaultinc.com, MyDirectives.com or this TEDx Talk.
About the eHealth Exchange
The eHealth Exchange, a 501(c)3 non-profit, is among the oldest and largest health information networks in America and is most well-known as the principle way the federal government shares data between agencies and with the private sector. The eHealth Exchange network, which is working in 75 percent of all US hospitals, is leveraged by more than 30 electronic health record (EHR) technologies and 61 regional or state health information exchanges (HIEs). Four federal agencies (Centers for Medicaid and Medicare, Department of Defense, Department of Veteran Affairs, and Social Security Administration) participate in the network to share patient information with private sector partners as well as other agencies. In all, the eHealth Exchange supports secure exchange of the records of more than 120 million patients. www.ehealthexchange.org / @ehealthexchange
About Zen Healthcare IT
Zen Healthcare IT is an interoperability technology and consulting firm. Zen helps all stakeholders in healthcare – vendors, providers, payers, HIEs, and ACOs – simplify interoperability. Using technology tools and years of interface development and support experience, Zen’s solution architects and engineers design and build use-case driven solutions for health information exchange. The Zen team solves problems ranging from data acquisition, data normalization and aggregation, and data delivery challenges. Zen’s national client-base leverages Zen’s broad range of services, on-demand engineering, and disruptive Gemini Integration as a Service platform helps overcome interoperability obstacles and creates sustainable health information exchange infrastructures. Learn more at http://www.ConsultZen.com.