![]() While the long-term effects of COVID-19 are still unknown, many patients looking to return to normal life post-COVID are finding this more difficult than expected. Billing, Insurance & Financial Assistance. ![]() With day to day life feeling particularly uncertain, it is nice to feel like something is still your choice. As such, it is critical that we start talking about the end of life, before it’s too late. It is a grim reality, but a reality, nonetheless. It is inevitable that we will be talking about and exposed to death during COVID-19. This definition is key in these conversations and different for everyone. These conversations should include discussing what matters most to them, considering what they are willing to undergo for a chance to get better, and quality of life. And, everyone with a serious underlying medical condition should do the same with their family and physicians. In fact, every nursing home and assisted living facility should immediately talk to their residents about how they would like to be treated if they have a serious case of COVID-19, and who will speak for them if they are unable. Centers for Medicare & Medicaid Services and Centers for Disease Control and Prevention to institute guidelines encouraging the discussion, so professional medical societies, clinicians and families will start talking. The need to have clear advance directives and discussions about life support is critical and realistic for all of us always, but especially now. ![]() To some, it might seem a bit morbid or feel like fear-mongering to have these conversations-but it is not. Perhaps through taking back control in even the smallest way, our own fears and anxieties about the unknown can be lessened, and maybe even our anticipatory grief. For example, residents at Massachusetts General Hospital decided to complete advance directives and assign health care proxies during their shifts at work. Even trainees are having these important conversations. But they also talked about how they’d rather die at home than be in the hospital and traumatize their own colleagues who would then have to care for them. They discussed their kids and their pets and their emergency contacts. Rana Awdish, an ICU physician at Henry Ford Health System and author of In Shock, wrote on Twitter how she and her colleagues came up with and shared their plans if they were to get sick. With a looming dwindling of hospital-based resources, this will also require putting critical infrastructure in place now for hospice programs to deliver medications that relieve suffering for patients in nursing facilities and in their own homes.Īware of this reality, doctors have even started addressing their own end of life wishes and sharing them publicly to encourage others to do the same. In order to meet that challenge, we need to build the capacity for more palliative care to be provided at scale. But the speed and severity of COVID-19 will make that difficult. ![]() Ideally, palliative care starts early, at the time someone is diagnosed with a life-limiting condition. We need to be able to communicate effectively with them and their families early on to understand their wishes and be able to provide high quality palliative care in the ICU and eventually hospice. Practically, this means we should identify those at highest risk from serious illness and death and then discuss with them whether, in a worst-case scenario, they would want hospitalization and use of a ventilator in the ICU, which could reduce the impending need for rationing care based on who will most likely benefit from mechanical ventilation. Because the country is not likely to meet these needs in time, we must prepare for this emotional and physical onslaught in other ways. could have a shortage of some 1.3 million hospital beds and 295,000 ICU beds. The current projections indicate that the U.S. Given that we know only a minority of elderly people and those living with serious illnesses who are put on ventilators will survive this pandemic to leave the hospital, this is a reality that must be discussed now. Bioethicists have weighed in on the need for hospitals to create triage committees, a team of nurses and doctors that evaluate COVID-19 cases and remove the burden of rationing care from the individual providers. Some hospitals are considering a do-not-resuscitate policy for all infected patients. In the new era of COVID-19, the protocols aren’t as clear. ![]()
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