Advance Care Plans Are Critical to Optimal Patient Care

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, the world’s leading all-digital advance care planning platform.

San Diego Union-Tribune: Nursing homes must act to control COVID-19. Here’s how.

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.