IFA Virtual Town Hall Chat Summary 5 June 2020

The following chat summary is from the IFA Virtual Town Hall on 5 June 2020 with Mr. Daren Heyland, sharing on COVID-19 as a threat to person-centered care.

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Key Resources:

• Plan Well Guide
• My ICU Guide
• CANHELP Questionnaire
• Mosaic Home Care Services: A Bigger-Picture solution bringing meaning to end-of-life and advance care planning

Upcoming Events

IFA Virtual Town Hall – COVID-19 and Older People: Grandparenting in a Pandemic
Friday 12 June 2020 at 7:00 am Toronto EDT

Mosaic Home Care Services and European Society of Person Centered Care
Person Centered Care Conference
September 2021 in Toronto, Canada
More information: http://pchealthcare.org.uk/

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Language of advanced-care planning

• It is important to differentiate between serious illness/advanced-care planning and end-of-life planning.
• Person-centeredness in advanced-care planning involves consultation of the patients’ wants and values towards end of life but also regarding their goals for recovery. Consultations should address the possibility of long-term functional decline and long recovery period following some life-saving interventions.
• Some people provide directives to their health care professionals or for their file at their long-term care facility. These directives primarily refer to end-of-life wishes rather than advanced-care planning.
• When consulting with health care professionals, patients and caregivers may experience a combination of not knowing what questions to ask about treatment options and being afraid to ask them. There is apprehension among patients and caregivers about discussing advanced-care planning or end-of-life care.
• In the absence of family, healthcare proxies may be assigned help in communicating to health care professionals the needs and values of older people with respect to end-of-life care.
• Providing a different lens to ‘advanced-care planning’ is very helpful. For instance, upon arrival in Intensive Care Unit (ICU), symptoms may not indicate the patient is experiencing an ‘end-of-life’ event, so patient’s advanced-care planning directives focusing on desired quality of life and recovery would be more pertinent than end-of-life directives.
• How does elder abuse figure in health care professionals’ consultations about advanced-care planning?

Physician and patient roles

• It is important for physicians to receive training in interview techniques for people with different speech or cognitive abilities. It would also be helpful to instruct the family on how to engage with the physician in a structured dialogue.
• It was discussed that sometimes the patient arrives at night, distressed or unconscious, and may be unable to communicate their wishes with respect to advanced-care or end-of-life directives.
• Suggestion to include the topic of advanced-care planning discussions beginning at the undergraduate level of medical education.

System models

• The current situation is showing that person-centered care is important and can help bring advanced-care planning into health care consultations. Structures must be in place to implement person-centered care.
• Important to implement quality indicators that measure patient/caregiver satisfaction and link to physician and/or system performance evaluations.
• A 2005 Canadian report around SARS acknowledged the potential for Personal Support Workers getting sick during a pandemic and recommended to train family members on personal care for their family members residing in facilities. Training could also include advanced-care planning.
• There is interest in identifying priority research areas for developing countries regarding person-centered care in light of COVID-19.

Effects of COVID-19

• There is concern that the number of people seeking medical attention for serious problems such as potential heart attacks or strokes decreased during COVID-19. This may be because patients believe they need an advocate with them to navigate pandemic triaging protocols and to ensure they receive appropriate patient-centered care. Due to some medical protocols during COVID-19 patients are required to be isolated so many patients hesitate when seeking medical care.
• Healthy and fit individuals over 50 years old is that typically they seek medical attention once they have serious symptoms i.e. coughing blood, at which point symptoms can worsen quickly and may not allow for fulsome consultations about advanced-care planning.
• Dying in isolation as a result of COVID-19 is a serious concern regardless of age.
• During the COVID-19 outbreak the focus in long-term care has been on infection prevention and control rather than quality of life. This has resulted in family members being excluded from long-term care settings. These people often are important members of the care team and advocates for quality of care and quality of life of the resident. It is important to seek a better balance in the current and future outbreaks.
• Frontline (WBGH Boston) is a television program about COVID-19 from the point of a doctor. This program may be available on YouTube internationally, and on PBS in the U.S.