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December 11, 2020
In response to COVID-19, the NJ Long-Term Care Ombudsman (NJLTCO) and the Goals of Care Coalition urge skilled nursing facilities (SNFs) to engage in advance care planning with their residents, as required by state law, to ensure that these seniors have the emergency and/or end-of-life medical treatment they want.
“As we have seen, nursing home residents are uniquely vulnerable to the coronavirus since they are older, often with underlying medical conditions, and living in a congregate setting that can increase risk of exposure to COVID-19,” said NJ Long-Term Care Ombudsman Laurie Facciarossa Brewer. “Residents have a right to receive care and treatment consistent with their preferences, should they become ill.”
The NJLTCO recommends that nursing homes and other SNFs educate all residents/decision makers about the higher risk of severe illness and death from COVID-19 for older and seriously ill persons, as well as treatment options available in-facility and out-of-facility.
SNFs are asked to familiarize their residents and advocates with such concepts as palliative care, Do Not Resuscitate (DNR) orders, advance care directives and where needed, Physician’s Orders for Life-Sustaining Treatment (POLST).
Facilities should record residents’ preferences in their medical records with appropriate orders, using a POLST if appropriate and, if possible, an advance care directive; and to create an emergency treatment plan that reflects resident preferences, including whether the resident wants to be transferred to an acute care hospital for treatment of severe COVID-19 symptoms.
Please review the Advance Care Planning During the COVID-19 Crisis dated December 10, 2020 for the full text.
Residents should be advised that cardiopulmonary resuscitation (CPR) is the default treatment for cardiac arrest and will be started unless there is an existing valid DNR order documented in the resident’s medical chart or POLST form.
Further, The NJLTCO asks facilities to implement policies to identify and address end-of-life care issues for patients and residents upon admission to the facility. They also should make sure any residents’ existing emergency documents are up-to-date.
The NJLTCO also suggests that facilities develop a telehealth program to support advance care planning conversations and rapid virtual access for residents and families to community palliative and hospice care services.
Additional resources to support advance care planning, including POLST forms in multiple languages, free videos for patients and family decision makers explaining POLST, and POLST instructions for healthcare professionals are available from the Goals of Care Coalition of New Jersey and many of its member organizations.