Pandemic underscores crucial need
to update your Advance Directives
By Ron Fischler, MD
While most older Americans agree that
it’s important for their family and doctors to be aware of their
end-of-life care goals, surprisingly few have initiated that
conversation. Even fewer have put down in writing what they want and
what they don’t want if time is short.
COVID-19 now has more cases in the US
than anywhere else and continues to rise at an alarming pace and
threatens to overwhelm hospitals and ICUs nationwide. Everyone is
cautioned to stay at home, maintain distance from others outside the
household, wash hands, avoid touching the face in order to “flatten the
curve” of new cases per recommendations by leading
It is known that for older people,
the chance of dying from COVID can be high, depending on age and what
other diseases the person may have.
While the majority of infections are
mild, older persons are more likely (20%) to be hospitalized if they
become ill, and 25%-50% of those may develop what’s called interstitial
pneumonia, complicated by ARDS (adult respiratory distress syndrome) and
multiorgan failure after about 5-10 days of illness. Rapid
deterioration is likely. Although data are still limited, some studies
suggest only 25%-50% of high-risk older people will make it out of an
ICU alive; spending weeks on a ventilator is not unusual and very few
patients return to their state of health before COVID. With a
shortage of ICU beds and ventilators predicted, criteria are being
developed to ration their use based on who may benefit the most.
If you are over 65 and, especially if
you have chronic lung disease, heart disease, cancer, chronic liver or
kidney disease, diabetes or autoimmune disease, it is time for you to
think about how you want to be treated if you became gravely ill with
COVID. Would you want to be admitted, alone (no visitors), to an ICU
where you would likely have a breathing tube inserted in your throat,
and you would be kept paralyzed and heavily sedated.
Alternatively, you could make prior
written arrangements to be given oxygen, medication for pain and
anxiety, and “comfort care” if there is no hope for your recovery. This
course of action could be followed at home or hospice where you could be
close to loved ones until your inevitable passing. April 16 is National Healthcare Decisions Day,
as organized by the Conversation Project, a nonprofit initiative with a
goal that is both simple and transformative, i.e. to have every
person’s wishes for end-of-life care expressed in writing and respected
by both families and physicians.
dies sooner or later, and having a comfortable death is possible with
planning. If you unsure about how how to start the conversation with
family or your doctors, visit this site TheConversationProject.org/
If you need forms
to complete your Advance Directives (Do Not Resuscitate order, and
other details like ventilation, feeding tubes, antibiotics etc.) plus
forms to appoint a health care proxy (power of attorney) who is
authorized to speak on your behalf in the event that you are not able to
do so, you will find online assistance here ThoughtfulLifeConversations.org/
For everyone at
this time, finding and expressing gratitude, asking for and receiving
forgiveness, being kind to one another and being clear about your
wishes are all key to a life well lived and (if this is your time) to a
peaceful and comfortable death.
Deaths surge in senior care facilities
encouraging signs from coronavirus hot-spots around the globe, more than
3,600 recent deaths in US nursing homes and long-term care facilities,
have residents, staffs and medical workers unnerved.
federal government has not been releasing a count of its own, the
Associated Press has kept its own running tally based on media reports
and state health departments. The latest count of at least 3,621 deaths
is up from about 450 deaths just 10 days ago.
But the true toll
among the 1 million mostly frail and elderly people who live in such
facilities is likely much higher, experts say, because most state counts
don’t include those who died without ever being tested for COVID-19.
Outbreaks in the
past few weeks have included one at a nursing home in suburban Richmond,
Virginia, that has killed 42 and infected more than 100, another at
nursing home in central Indiana that has killed 24 and infected 16, and
one at a veteran’s home in Holyoke, Mass., that has killed 38, infected
88 and prompted a federal investigation. This comes weeks after an
outbreak at a nursing home in the Seattle suburb of Kirkland that has so
far claimed 43 lives. And those are just the outbreaks we know about.
Most states provide only total
numbers of nursing home deaths and don’t give details of specific
outbreaks. Notable among them is the nation's leader, New York, which
accounts for 1,880 nursing home deaths out of about 96,000 total
residents but has so far declined to detail specific outbreaks, citing
nursing home deaths may keep climbing because of chronic staffing
shortages that have been made worse by the coronavirus crisis, a
shortage of protective supplies and a continued lack of available
testing. Deaths have escalated in spite of steps taken by the federal
government in mid-March to bar visitors, end all group activities, and
require every worker to be screened for fever or respiratory symptoms at
continue to find their way into nursing homes because screenings didn't
catch people who were infected but asymptomatic.
Last week, the
federal Centers for Medicare and Medicaid Services issued
recommendations urging nursing homes to use separate staffing teams for
residents, and to designate separate facilities within nursing homes to
keep COVID-19 positive residents away from those who have tested
Action Network Administrator
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ABOUT US: We are an all-volunteer, nonpartisan, nonsectarian grassroots coalition
dedicated to passage of a state law allowing terminally ill residents to obtain
prescription medications that eliminate undue suffering at the end of life and assure a
dignified, peaceful passing. Our purpose, goals and proposed legislation
are modeled after our highly respected national partners: Death with
Dignity and Compassion & Choices.
The end-of–life practice we endorse is called medical aid in dying (MAID).