In The Time Of Covid, Make Tough Decisions With A Clear Mind. Advance Directives Are More Important Than Ever
Big discussions now save bigger headaches later.
Last Will and Testament, Power of Attorney, Advance Directives – these are all intimidating concepts. It’s no wonder many people avoid, or put off for too long, the execution of these important legal documents. These are necessary items for folks of any age, but even more so it is important to keep them current in the age of a global pandemic. Yes, COVID-19 has brought along new considerations for people facing severe complications. Let’s break it down.
End-of-life guidance protocols are set forth in an Advance Directives document, aiding care providers and family members in implementing your final wishes. You write your directives consistent with your beliefs and values, your ethics, and your desires for care in your final phase of life. Topics such as when to administer or stop life support, heart resuscitation, respirator use, or coma-care management are examples of what is included. Selecting a health proxy is part of it. This is someone who can act on your behalf when you are not able to make decisions on care. This is someone who knows you and your preferences and, ideally, with whom you have discussed your advance directives wishes.
You can see how the onset of COVID-19 would impact such decisions in ways you may not have previously considered. Going to the hospital is a typical reaction to severe illness. However, during the time of COVID, this results in certain isolation and the inability to be with family during what may be your last days. Where do you stand on that balance of seeking potentially lifesaving care, and dying peacefully amongst loved ones?
We know that COVID-19 effects people of age more severely, and people with underlying health disorders are at higher risk of extreme cases or death. These are all components to factor into your decision making.
If you have a current Advance Directives in place, it is recommended that you create a COVID-19 specific addendum to address the progression of care that may occur with this virus. This is a new virus, so there is not much clinical outcome data to guide your decisions. We know that it may present more severely than acute respiratory distress syndrome, making the time on a ventilator longer, and recovery more difficult. But with COVID-19, recovery is possible, possibly more so than with other causes of ventilator use. You may want to schedule a tele-consult with your physician to discuss any underlying health concerns and how it might impact your end-of-life decisions should you contract the coronavirus.
Check your insurance for coverage of such discussions. Medicare does provide for two advance care planning telehealth session of up to 30 minutes each. Reimbursement codes are 99497 and 99498. For patients with cognitive impairment the reimbursement code is 99483 (1). Also, be sure to check your state laws to see what they require as each state has different guidelines and terminology.
In addition to your Advance Directives, you need to put into place your Power of Attorney. This goes above and beyond your health proxy. Your Power of Attorney has the ability to make transactions, on your behalf, of a health and/or financial nature. There are several types of Power of Attorney. In case of medical incapacitation, you will want a Durable Medical Power of Attorney, which remains in effect even if you become incapacitated. You can download a free form at Law Depot: https://www.lawdepot.com/contracts/power-of-attorney-form/?loc=US#.Xw3aUUVKhPZ . And having a Last Will and Testament in place is always a good idea. Without one, you leave your assets to the courts to distribute as they see fit. Law Depot also offers free forms for this or to be sure you have factored in all considerations for your family, consult with a legal professional.
Aside from all the legal documentation, a good place to start is with your family plan (2). The CDC offers some tips to help families establish a plan for the situation where one of your family members contracts COVID-19. Take steps such as identifying an isolation room in the house for anyone who gets sick, putting preventative measures in place to protect everyone, especially members at a higher risk, such as disinfecting common areas and frequently touched items like refrigerator doors, microwaves and faucets regularly.
In the time of COVID, making tough decisions now, with a clear mind, not in the hour of need, is the best path to take. There are many resources available and we are here to help should you need long term care or rehab options for someone in your family.
- Compassion & Choices, COVID-19: Advance Care Planning https://compassionandchoices.org/resource/covid-19-advance-care-planning/
- Centers for Disease Control and Prevention, Corona Virus Disease 2019 (COVID-19), Household Checklist, Updated June 13, 2020 https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/checklist-household-ready.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fdaily-life-coping%2Fget-your-household-ready-for-COVID-19.html