November is National Palliative Care and Hospice Month, and the 2023 theme of “Courageous Conversations” is a fitting one.
Considering that nearly 95 percent of older adults are affected by at least one chronic condition, according to the National Council on Aging, the problem is widespread to say the least. The earlier someone and their children and caregivers start discussing the realities of their illness — and of aging overall — the better the aging experience can be.
“In observing this month, we shine a light on the important work that providers do for patients suffering with serious and life-limiting illnesses,” says Dr. Chantal Walsh, Post-Acute Telemedicine Medical Director with Sound Physicians. “In my 20-plus years in post-acute care and geriatrics I have seen a lot of death. This is understandable, given that most of my patients are at or near the end of life. Sadly, I have also seen a lot of needless suffering and the indignity of losing control in the face of death.”
But death and dying don’t have to be this way.
“It is possible for a patient to die with dignity, in accordance with their wishes and values,” she says. “Advance care planning allows this.”
Understanding advance care planning
Advance care planning (ACP) helps patients and families guide their future health care decisions based on their values, beliefs, preferences and specific medical issues. Out of this planning, advance directives are born— the legal documents that provide instructions about an individual’s health care wishes if they are unable to participate directly in medical decision-making.
But advance directives — such as a Do Not Resuscitate order, Power of Attorney, Living Will, Physician Orders for Life-Sustaining Treatment and organ and tissue donation — are only one aspect of ACP. This is a process, not an event, and involves several steps, all of which skilled nursing providers should know.
For patients and families, ACP involves:
- Thinking through relevant values and preferences
- Communicating values and preferences to their spokesperson, close family members and health care providers
- Completing advance directives and ensuring the documents are in the medical record
- Reviewing advance directives periodically and updating them as needed
As Dr. Walsh notes, ACP discussions should happen at every SNF admission.
“A lot can change from the ICU to the SNF,” she says. “If the patient is admitted after hours, Sound’s telemedicine providers can start this inquiry and make note of it in the assessment and treatment plan recommendations.
“Additionally, every patient care conference is an opportunity to review advance directives and make any updates. There should be triggers for having advance care planning discussions, such as frequent hospitalizations, progressive cognitive or functional decline, major acute life changes such as significant stroke or fracture, failure to thrive or loss of a spouse. Telemedicine providers can sometimes spot these opportunities and note them in the treatment plan.”
The SNF opportunity to join the courageous conversation of ACPs
As Dr. Walsh views it, SNF operators and staff have the privilege of participating in ACP discussions and should embrace that opportunity. These courageous conversations can help families prepare for the death of a loved one according to previously expressed wishes, can mitigate the possibility of family conflict and can help survivors cope with bereavement. SNFs are often the guardians responsible for honoring the wishes of long-term care patients.
“Participating in ACP should be thought of as a gift — for the patient and their loved ones,” Dr. Walsh says. “The peace of mind it can bring to the patient also cannot be overstated. It is a privilege that should be cherished as well as honored.”
This article is sponsored by Sound Physicians. To learn more, visit Sound at soundtelemedicine.com.
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