The COVID-19 pandemic is shedding new light on the often-abstract concept of advance care planning, where individuals document what matters most to them, and then select the right health care agent to make decisions on their behalf if they are unable to speak for themselves. During this pandemic, many people have had to make medical decisions for loved ones who were unable to communicate.

National Healthcare Decisions Day, observed on April 16, is the day selected to encourage family discussions and advance care planning.

“Advance care planning gives patients peace of mind in knowing that health care decisions will be made on their behalf by a person they trust,” said Patricia Bomba, M.D., vice president of geriatrics at Univera Healthcare. “For health care agents, advance care planning gives them the confidence to make decisions based on their loved one’s values and beliefs.”

Completing or updating a health care proxy can be done at an office visit to the individual’s physician, nurse practitioner, or physician assistant. The practice of social distancing may require this to be done with a telemedicine visit via telephone or by using video conferencing technology such as Skype or ZOOM. 

The health care proxy form requires two witnesses to the signature. This can be accomplished in person, or by using video conferencing technology. A photo of the signed health care proxy can be mailed to the health care provider or uploaded to the medical practice’s secure patient portal. Individuals also should email a copy to family members. 

If video conferencing is unavailable, speak with your physician, nurse practitioner, or physician assistant about the process for providing verbal consent over the phone. And, if a patient is unable to sign a health care proxy, the name of their chosen health care agent, and their stated values and beliefs for care, can be documented in their medical record and treated in the same way as an oral advance directive. 

Individuals with an advanced illness or advanced frailty, are advised to reach out to their physician or nurse practitioner to discuss the Medical Orders for Life-Sustaining Treatment (MOLST). MOLST reflects a patient’s preferences for treatment, including resuscitation, respiratory support on a ventilator, and hospitalization. It is based on the patient’s current health status and prognosis. 

“MOLST is not an advance directive and is not for healthy people,” said Bomba. “It is a set of medical orders signed by a physician or nurse practitioner that must be followed.” 

Univera encourages all adults ages 18 and older to start advance care planning conversations with their health care providers, family members and trusted friends. Then, they should complete a health care proxy to formally name a health care agent.

Univera led the development of a free community website, CompassionAndSupport.org, that includes information on advance care planning, free downloadable forms and instructional videos and MOLST.org, that includes COVID-19 Guidance on MOLST, eMOLST and how to have thoughtful MOLST discussions.

Peter B. Kates is vice president of communications for Univera Healthcare.

 

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