The SARS-CoV-2 (COVID 19) pandemic has changed the landscape of how we care for our vulnerable elderly. Institutionalized elderly residents of nursing facilities bare a disproportionate burden with a higher number of deaths in the very old, greater than 80 years. In an attempt to offset the deleterious effects, our seniors in long-term care have been isolated from their families and peers. The purpose of this research is to understand the impact of social isolation as it pertains to advance care planning (ACP) and hospitalizations and evaluate any mitigating factors which may impact these measures.
Method: Observational qualitative study: using experiential data in the form of close ended and Likert scale survey questions with and open-ended question at the end giving the advance practice clinicians (APC) the opportunity to describe experiences/observations. Sample population included complex care management advance practice clinicians in the state of Florida practicing in long term care facilities. The survey was sent to 95 APC’s with 46 responding; 35 were accepted for study purposes. Surveys were excluded due to incongruence in answers or failure to complete Likert scale.
Results: Identified groups; group A - no changes to ACP; group B – changes to ACP related to social isolation; group C - changes to ACP not related to social isolation. Group A had more frequent touches with their reponsbile party and was more likely to have visualization by window or video chat as a mitigation intervention; group B had changes to APC which were initiated by the responsible party (RP) with less frequent RP interaction and was less likely to be offered a visualization strategy to mitigate isolation. Group C experienced changes to APC not related to isolation found that changes were initiated by their facility in an effort to keep COVID-19 from spreading in facility. Rescinding of do not hospitalize status was the most frequent change to ACP.
Conclusion: Social isolation played a role in changes to ACP and hospitalization. Mitigation stratagies have been identified which may reduce the effects of social isolation during a pandemic. Thereby, preserving advance care plans and reducing hospitalization burden.
Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.