HOLMDEL, NJ: The COVID-19 pandemic has brought about a keen awareness of our own mortality. It has provided food for thought raising such questions as:  How do I want to spend my final days? Do I want life-sustaining treatments?  Do I want to die at home? 

Regardless of your age or health status, now is the time to make sure you have clearly outlined your preferences for end-of-life care. Among the higher risk, frail elderly population, advance care planning is even more critical. 

VNA Health Group’s home-based primary care team, Visiting Physician Services (VPS), has been having advance care planning conversations with their homebound elderly patients for years as part of the comprehensive services they provide. Dr. Sara Leonard, Medical Director for VPS, says “Now with the pandemic, end-of-life discussions have never been more important.  Those who are elderly with underlying chronic or serious illnesses are most at risk for complications from the coronavirus.  Understanding our patients’ wishes for end-of-life care helps us to keep their values and goals at the center of the care we provide for them.”

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As a practice that provides only house calls, VPS might discuss advance care planning at an initial visit when it appears to be an appropriate topic. These discussions are also timely when a patient returns home after a hospitalization or when there’s been significant change in the status of an acute or chronic condition.

Comments Leonard, “Advance care planning discussions are often delicate and difficult topics to broach and initiate.  They are usually guided by the patients and families along with our clinical intuition and experience. We generally include a discussion of the patient’s diagnosis and prognosis, time for the patient to ask questions and process information, and the opportunity to discuss his/her wishes for end-of-life. This may include reviewing options and completing an advanced directive.”

A large percentage of advance care planning discussions result in the completion of a POLST form, Physician Orders for Life-Sustaining Treatment. The POLST form ensures that a patient’s end-of-life wishes are formally documented. Completing a POLST form has become vital in today’s environment as severe cases of the coronavirus disease lead to an increase in deaths.

In addition, studies show that advance care planning can reduce hospitalizations, reduce health care costs, increase community-based palliative care and hospice utilization and significantly increase the likelihood that care will be delivered in accordance with the patient’s wishes. 

Leonard concludes, “At its core, advance care planning is one way to ensure that patients receive the care that reflects and supports what matters most to them, especially in situations where they cannot speak for themselves. With many coronavirus patients dying alone, without loved ones nearby for comfort or readily accessible to advocate for their end-of-life wishes, advanced care planning discussions help to alleviate some of the fear and uncertainty in critical situations.”

Visiting Physician Services, headquartered in Holmdel and part of VNA Health Group, is the largest physician-based geriatric house call practice in New Jersey. Their clinical staff is comprised of 7 physicians and 30 nurse practitioners and physician assistants, who work as a team serving 3,400 active patients throughout Bergen, Passaic, Union, Essex, Middlesex, Somerset, Monmouth, and Ocean Counties. Their mission is to enable patients to stay at home as they age by providing quality in-home medical care. Visiting Physician accepts Traditional Medicare and Horizon Managed Care. For more information about Visiting Physician Services, please call 732-571-1000 or visit www.vnahg.org/vps.