The cross-continuum push for healthcare decision-making takes on new meaning in the wake of COVID-19 and the intense pressures on caregivers

April 12, 2023 – In the wake of the expiring public health emergency and persistent capacity constraints within healthcare facilities, a coalition of leading organizations is coming together to promote proactive care decision-making by calling on patients to designate a healthcare agent and complete a health care proxy document.

This call to action is championed by advocacy groups from across the continuum of care, including the Massachusetts Health & Hospital Association, Honoring Choices Massachusetts, the Massachusetts Medical Society, the Home Care Alliance of Massachusetts, the Massachusetts Senior Care Association, LeadingAge Massachusetts, and the Hospice & Palliative Care Federation of Massachusetts.

The coalition is urging every patient to designate a healthcare agent, or the person trusted to make care decisions on your behalf if you are unable to make them for yourself. The importance of proactive decision-making became especially evident during the COVID-19 pandemic, when thousands of patients across the nation were incapacitated and in need of representation regarding their care.

Completion of a health care proxy, the simple form patients can use to assign their agent, can also help alleviate some of the intense pressures healthcare organizations are now experiencing. Proxies empower caregivers to work directly with trusted loved ones and efficiently transition them to other care settings from the moment their hospital stay is winding down. Hospital case managers report that when patients lack a healthcare agent, it prevents them from being discharged and ties up acute-level beds for other patients in need. Patients do not get the level of care they need, while hospital wait times and care access for other individuals suffer.

To advance this effort, the coalition created a Healthcare Decisions Toolkit, through which provider organizations can share resources and information about healthcare planning that supports providers, empowers patients, and reduces barriers to receiving emergency and inpatient care.

“Every adult can take a simple but powerful step to direct their health care choices” said Ellen DiPaola, president & CEO of Honoring Choices Massachusetts. “It starts with a simple conversation to appoint a trusted person to work in partnership with healthcare providers to provide timely care, if you are not able to speak for yourself.  As trusted messengers within their communities, our coalition is encouraging every healthcare organization to help spread this message as the public health emergency comes to an end.”

“Assigning a healthcare agent is about empowering patients and families to protect their care choices. But it’s also about supporting our local providers and caregivers who are striving to keep care accessible,” said MHA Vice President of Clinical Affairs, Patricia Noga, PhD, RN. “For those wondering what they can do to help support our hospitals and health systems at this critical time, completing a health care proxy is something you can do today.”

The coalition is highlighting three key steps for community members:

1. Choose someone you trust to be your designated healthcare agent and have a simple conversation about what’s important to you.
2. Complete a health care proxy form – you can do it all yourself! (The form is available in 15 languages.)
3. Have a simple conversation with your care team about the care that’s right for you.

“Making a decision in your medical care choices when you cannot speak for yourself is available to all patients 18 years and older”, said Massachusetts Medical Society President Theodore A. Calianos, II, MD, FACS. “By choosing a health care agent, having a conversation about what matters to you, and completing a proxy form no matter your age or health status, you will ease concerns for your family, friends, physician, and others involved in your care.”

“As long-term care providers, we are entrusted with caring for vulnerable seniors and individuals with disabilities for whom a health care proxy is extremely important, said Tara Gregorio, president of the Massachusetts Senior Care Association.  “We are committed to supporting the work of the coalition and our members will continue their efforts to educate residents, family members and caretakers on the importance of completing a health care proxy so that each resident’s wishes regarding medical care are honored.”

“The Healthcare Decisions Toolkit is a wonderful resource to support home health clinicians working to empower and educate the patient to make proactive decisions about their care”, said Jake Krilovich, executive director of the Home Care Alliance of MA.  “The clinicians in home health have a wonderful opportunity being in the patient’s home to engage the family in supporting the patient to designate a healthcare agent and to help identify and reduce barriers to receiving care.

LeadingAge Massachusetts’ not-for-profit providers of aging services have been working for years to help educate consumers, family members and staff about the critical importance of naming a health care agent and talking with them about what matters most,” said Elissa Sherman, president of LeadingAge Massachusetts.  “This toolkit is another important resource available to help providers with these essential conversations.” 

“Making the time to start a simple conversation to thoughtfully complete this step-by-step toolkit, assigning an agent, and noting healthcare preferences will make all the difference when time is of the essence,” said Christine McMichael, executive director of the Hospice & Palliative Care Federation of Massachusetts.

The Healthcare Decisions Toolkit includes an array of valuable tools for hospitals and healthcare systems, including messaging, informational materials, and graphics. It also includes instructive videos on how to submit the health care proxy form and how to facilitate conversations around healthcare decisions.

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