Aging Life Care in the Age of COVID-19
I got the text at 11pm on a Saturday night last week. An elderly frail couple that we were consulting on for many years and who were aging in place with a variety of co-morbid conditions had both developed raspy coughs and waxing and waning low-grade fever. The couple in the past had dodged multiple infections and were like cats with nine lives. Many times, in collaboration with their dedicated physical therapist we were able to manage symptoms at home with a visiting nurse practitioner house call service and on rare occasions one or the other were briefly hospitalized for a more acute complex but treatable illness. This couple despite their physical frailties loved each other deeply and each stayed alive for the other.
This time however, I knew it was going to be different. In the age of Covid, the hospital represented not only a serious risk to the couple, it would involve their isolation and separation in way that was different from before. In discussions with their health care proxy who despite living far away in the heartland was always a powerful advocate for them, the decision was difficult but true to their testament of love to each other. It was time to call in a hospice service so that they could remain together, touch each other and be present to witness whatever life each of them had left. Maddie died six days later of presumed Covid-19 lying next to her husband. With the support of a home hospice nurse her symptoms were expertly attended to by a team of amazing frontline caregivers that had known the couple for ten years. Paul her husband was present and aware at her death. He shed his tears quietly and graciously and a day later he stopped eating or drinking. He joined her ten days later.
These are unsettling times indeed for us who work with vulnerable older populations. As Aging Life Care professionals we have always worked tirelessly to reduce hospitalizations for our clients but now in the age of Covid-19 there are immediate life and death consequences as cases flood the emergency rooms and hospital units across the country.
In preparing for the pandemic, I and my care management team members upped the ante on advancing the conversation around what kind of aggressive medical care our clients wanted. Many of them had planned with us and completed MOLST forms (medical orders for life sustaining treatments) https://www.health.ny.gov/professionals/patients/patient_rights/molst/. This directive is much more specific than a Health Care Proxy or Do Not Resuscitate and offer choices of specific directives including a Do Not Hospitalize. For those families that didn’t want to or simply couldn’t go there emotionally, we gently revisited the conversation so that the consequences could be understood in the current climate. There is no wrong or right decision here – it is all about staying true to loved ones wishes especially as it relates to what an end of life experience will be. When the tidal wave of this pandemic eventually reduces to an ebb and flow of smaller waves, we collectively as a society need to be brave and courageous and peer deep inside ourselves and examine what our mortality means to us. Recommended reading and resources on this topic include Atul Gwande’s “ Being Mortal” http://atulgawande.com/book/being-mortal/ and the Conversation Project https://theconversationproject.org/