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How COVID-19 Has Increased the Need for Digital Advance Care Planning

How COVID-19 Has Increased the Need for Digital Advance Care Planning

Many people believe that future care planning or advance care planning (ACP) is a process reserved for those who are extremely old or sick or frail. However, the emergence of COVID-19 has had a significant effect on the way we think and talk about advance directives and other ACP documents. Advance care plans are relevant to all adults, both young and old, preventing unnecessary stress and confusion about healthcare decisions.

writing-signing-document-paper-formEvery patient has a unique set of circumstances and priorities, and a digital ACP document allows that patient’s personal healthcare wishes to be understood as simply and directly as possible. It does this by offering healthcare providers and loved ones a clear set of directives. These instructions help to remove ambiguity from the healthcare decision-making process should the patient be otherwise unable to communicate.

People postpone creating an ACP document for a variety of reasons:

  • They might be young and relatively active or healthy
  • Thinking about a serious or incapacitating incident can be uncomfortable
  • Creating an effective plan might be confusing

COVID-19 revealed the shortcomings in these thought processes. Any number of people who considered themselves reasonably healthy, including those who successfully managed health conditions such as diabetes or high blood pressure, suddenly found themselves more vulnerable than they’d originally thought they were.

COVID-19 made planning complex and sometimes impossible

A unique aspect of COVID-19 has been its unpredictability. While some patients overcome minor symptoms without hospitalization, others do not. From the onset of symptoms, patients can decline quickly, finding themselves in the emergency room or even on a ventilator within 24 to 48 hours. It can be an emotional and overwhelming experience, with ventilators preventing them from communicating their wishes to those in charge of their care.

The high transmissibility of COVID-19 also altered the way emergency rooms and hospitals operate. Because of the ongoing fear of contagion, family and friends haven’t had the same access to patients and doctors they historically would, obscuring another route to communication and planning.

file-folder-papers-stackIn addition, we’ve learned exactly how ineffective paper can be.

While paper advance directives have historically been a preferred method of ACP documentation, they’ve become a liability during this era. Many hospitals have been choosing not to accept paper documents out of concerns they could transmit the virus. Paper advance directives can also be unreliable, easily misplaced or inadvertently destroyed.

Only 2% of the advance directives that exist in print can be found and accessed when needed. An overwhelming majority of those 2% end up being discarded, because they contain ambiguous or conflicting instructions, or they don’t meet the necessary standards to show they are up to date or authentic.

A digital ACP document provides a deeper layer of protection

Having a digital ACP document in place means patients can both receive the care they want and avoid medical interventions they don’t want. In the case of an unforeseen circumstance, such as COVID-19, that digital plan does the work of reliably protecting and relaying patient goals, preferences and priorities.

Proactively preparing a digital advance care plan is simple and beneficial for everyone involved — including payer and provider organizations who reap a number of benefits, including:

  • Making each patient's goals and priorities accessible to ensure patients receive only the care they want
  • Reduced costs associated with high-quality care
  • Higher quality ratings
  • A higher rate of satisfaction among patients, families, caregivers, doctors and nurses

And yet, only a small percentage of the population has any kind of advance directive in place. In a recent study performed by Wilkinson, Wenger and Shugarman, people residing in nursing homes and suffering chronic illnesses only had ACP documents 33% of the time.


When trying to guess someone else’s goals and priorities for their care, spouses and doctors can and do get wrong some decisions regarding care. This happens 67% of the time!

Technology must play a role in ACP. There’s no other way to effectively streamline the ACP process and ensure the necessary information is included in the resulting ACP documents, all while keeping those documents secure and easily retrievable.

It’s time to normalize preparedness

Many people who historically wouldn’t have considered an ACP document to be worth the effort are now navigating a world that feels less predictable than before. They understand that, while they might be fine on a day-to-day basis, that dynamic can change quickly.

If we’re to normalize preparedness, there’s an opportunity for 75 million Baby Boomers who are at increased risk of serious injury and illness to lead the way. Fortunately, Baby Boomers have always embraced and created change.

However, this doesn’t mean younger generations can afford to postpone their own ACP documentation. A recent study by the U.S. Centers for Disease Control and Prevention reported that 36% of patients hospitalized with coronavirus were 65-84 years old, 17% were 55-64, 18% were 45-54, and 20% were 20-44.

Younger generations also juggle any number of conditions like obesity that might not seem immediately life-threatening but can increase their general level of risk. They can also experience unexpected incidents such as car accidents or sudden health scares. 

When the work of preparedness is performed prior to any imminent danger, it leads to far better healthcare outcomes. 

Health plans  and provider organizations have an important role to play

It’s vital that we adjust the way we think and talk about ACP. Payers and provider organizations play an enormous role in this process and it’s through their relationships with members and patients that care can be dramatically improved. 

Doctors can destigmatize the process of creating an ACP document by explaining it’s not simply done to address imminent concerns but as a normal and responsible action. This pragmatic outlook helps with conversations that might otherwise feel uncomfortable or unnatural. Many patients also have the perception that advance directives only apply to end-of-life scenarios. The truth is that having a plan in place pertains to any healthcare crisis.

One way healthcare providers can lead by example is by sharing their willingness to create their own plans.

The consequences of ignoring ACP are too high

Convincing patients of the value in ACP isn’t a difficult task. Studies have found that many patients want to have these conversations, they simply don’t know where to start or what resources are available to them. In order to give patients the control they desire, payers and providers can offer access to programs like those created by ADVault.

To ensure the best quality of care, all segments of the population need to have a high-quality ACP document in place. It should be digital (or, at least, digitized), securely stored, and able to be located, retrieved, and easily consulted at any moment in the point of care. Otherwise, future crises will once again result in care that’s both high in cost, low in quality and not addressing the actual needs of patients, their loved ones or the medical teams who are trying to treat them.

Contact ADVault today to discuss ACP solutions.

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