Author Archives: Dianne Savastano

What’s Your “Plan B?”

As we celebrate our 100th issue of Healthassist News, I find myself incredibly appreciative of all of you, my readers. That’s what I wrote in my “Gratitude Journal” this morning, part of my daily practice to help me reflect on my day, live in the moment, and manage the anxieties and fears that accompany an ongoing pandemic.

As I continue to look for silver linings during this challenging time, I find myself grateful for the pleasure of working with several clients who are not in crisis — but who are thinking ahead and planning.

All of these clients are caregivers, either for a parent, a spouse or a disabled child. Each has worked hard and done a wonderful job creating levels of support that meet the current needs of their loved one.

But now, they are experiencing anxiety as they ponder an important question: “What happens if something happens to me?” Today, I share examples of contingency plans we have developed to provide an answer.

Gary and Sarah

Three years ago, Gary and Sarah made a decision to have Gary’s 92-year-old father, Paul, live with them. They made some modifications to their home and created a space that was safe, but that also allowed everyone their privacy. Over time, Paul required physical help with activities of daily living and allowed Gary to assist, always saying that they would keep things between the two of them, permitting Paul to maintain his dignity.

Sarah provides additional assistance by cooking fabulous meals and, most important, socialization. They admire and respect one another and, for now, all is good.

When Gary called me, he wanted to discuss the following three scenarios

  1. What if something happens to dad and he comes down with a respiratory illness, presumably COVID-19? How do we honor his wishes to not go the hospital for treatment?
  2. What if something happens to me? How do I not place a burden on Sarah to care for my dad?
  3. What if something happens to both Sarah and me? Who takes care of dad?

Scenario #1 — What if something happens to dad?

For many families caring for older adults, a point comes when a decision is made to let nature take its course and to not intervene aggressively in the face of illness. Paul made this decision in the midst of the COVID-19 pandemic and communicated those wishes to Gary and Sarah.

Here’s what Gary and Sarah did to prepare for this possible scenario:

  • They scheduled a telehealth call with Paul’s primary care physician, to be sure she knew of his wishes and that Gary and Sarah supported his decision.
  • They agreed that in the event Paul became ill, his doctor would be notified immediately, and she would make a referral to Hospice.
  • They agreed that they would care for Paul at home, along with the Hospice team.
  • They identified a private homecare agency they could turn to if the need arose but, instead of waiting, they decided to hire some private, in-home help now, so that a relationship could develop and evolve with the agency.

Scenario #2 — What if something happens to Gary?

They decided that Sarah would continue to live with Paul, but she would not provide hands-on care.

Instead, they would ramp up the care provided by the private homecare agency, thus maintaining Paul’s privacy and dignity, and relieving Sarah of any greater burden.

Scenario #3 — What if something happens to Gary and Sarah?

In this scenario, they decided that while they would still like Paul to remain at home, there would need to be much more assistance — not only with hands-on care, but with life management overall.

Here’s what they did:

  • They discussed this possibility with their son and asked if he were willing to take on the responsibilities necessary for supporting this goal for his grandfather. He agreed that he would manage the finances and the property and would recruit the help of Healthassist to manage Paul’s healthcare, oversee the care in the home, and act as his eyes and ears to identify issues as they arose.
  • They created a “communication book” that outlined the essentials involved in Paul’s care, along with his personal preferences on a range of topics. This included Paul’s daily routine (timing of meals, favorite foods, favorite music, sporting events, etc.); specific activities for which he needs assistance, including details of how he accepts help; medical conditions he manages and a complete list of his medications, including the time at which he takes them.
  • They began to explore alternative living arrangements for Paul in an assisted living and/or long-term care environment, recognizing that even back-up plans may need a back-up.

Other contingency plans

Of course, Paul and Sarah are not the only clients with whom we have had similar consultations. Other examples of family discussions and back-up plans created include:

  • A mom and dad who began conversations with their adult children to plan for the care of a sibling with developmental disabilities, for when the time comes that the parents are no longer able to provide this care.
  • A daughter who finally agreed to call a family meeting with her siblings to ask for help, after having cared for her mom for years, and who until recently, had little desire for assistance from others.
  • A husband who began conversations with his adult children about their mom, who had a neurological condition that required 24/7 care at home, so they could all participate in the planning together.

Summary

The silver lining of this pandemic and the fears associated with it are the opportunities created for families to think ahead — families that under “normal” circumstances would usually wait for a crisis to occur before considering options.

Clearly, these are difficult conversations. However, as Paul and Sarah confided to me recently, there is a great deal of relief in laying out possible scenarios and developing back-up plans. In most cases, the worst option is doing nothing.

Recommended Reading: The Color of Covid

Racial and ethnic minority groups are at increased risk of contracting and dying from COVID-19. Historically, these groups have been less likely to be included in clinical trials for disease treatment.

The Color of COVID: Will Vaccine Trials Reflect America’s Diversity? discusses growing demands of drug makers and investigators to ensure that vaccine trials reflect the entire community.

Why Are More Black Americans Dying of COVID-19? looks at some of the underlying reasons for the racial disparities made visible during the COVID-19 pandemic.

Moving Forward In the Face of COVID-19

Over the past two months, I have joined with colleagues from across the country — Seattle, Los Angeles, New York, Chicago and Houston — to create webinars for fellow healthcare advocacy professionals on the impact of COVID-19.

One fascinating aspect of working in the healthcare industry during this unprecedented time is the just-in-time learning that is occurring as individuals with COVID-19 are being tested, diagnosed and treated in our healthcare system. Because this disease is new, no evidenced-based protocols specifically designed to treat the virus existed. Instead, symptom management has been the goal, with real time research contributing to new revelations and continuously improved and evolving care.

The Data (So Far)

Thanks to my colleague Io Dolka from Seattle, for the following information:

  • Approximately 55% of those who contract COVID-19 are between 18 and 64, but the majority (85-90%) of those who die from the virus are over the age of 75.
  • Those with underlying medical conditions, across all age groups, are more likely to pass from the virus.
  • Men die from COVID-19 more than women (60% vs. 40%) and the virus disproportionately impacts individuals of color.
  • An estimated 20% of individuals with COVID-19 are hospitalized; a subset (approximately 6%) of those require ICU care.
  • The virus spreads through close, prolonged contact with someone who may be symptomatic, pre-symptomatic (the 2-3 days before symptoms develop) and completely asymptomatic.
  • Breathing, speaking, loud talking, yelling, coughing, sneezing, and singing can spread the droplets of COVID-19.

What To Do Now

One thing is certain: We are living in an evolving environment, one that continues to necessitate behavioral change in all of us. Here are my recommendations for how to function, be prepared, and stay as safe as possible into the foreseeable future.

Regarding resuming normal activity

Know the facts, assess your personal risk, and mitigate that risk using your own decision making. Here are some questions to consider before you leave your home to mingle with others, return to work, etc.

  • What’s going on in my community regarding the incidence of cases and the capacity for healthcare, especially ICU beds?
  • How old am I?
  • Do I have chronic conditions such as heart disease, pulmonary issues, chronic kidney or liver disease, diabetes, or obesity?
  • Am I immunocompromised?
  • What is my gender and race?
  • How is my physical condition and overall health?
  • When I leave the house, where do I plan to go and with whom do I anticipate interacting?
  • What’s the space like that I will be in, how long will I be in it, and how far apart can I be from others?
  • If I chose to be with others, can we all agree to do a temperature and symptom check beforehand and commit to not participate if anyone has a temperature or has any symptoms, as minor as they may seem?

Regarding accessing healthcare

Communicate pro-actively with your primary care physician and follow the protocols their team has put in place to manage patients with COVID-19 symptoms. This may include testing recommendations and locations for physical assessments if needed, appreciating the turnaround time for receiving results. Use the Patient Portal to stay connected.

Overall, when seeking care for issues unrelated to COVID-19, asking about the protocols in place in each healthcare environment can ease anxiety, as you will know what to expect. For example, recently I had to drop my husband off at the door for a surgical follow-up appointment. Thanks to some pre-planning, I was able to attend the appointment via FaceTime.

Regarding your mental health

The presence of the virus and the required physical distancing can trigger new problems, such as anxiety or exacerbate existing problems such as depression. There have been increases in the incidence of mental health, substance abuse and related disorders.

If you are experiencing any of these issues, your primary care physician is a great place to start. Telehealth appointments with mental health professionals have made care more accessible and state-sponsored websites also list resources.

Consider developing a “ Gratitude Journal to note things you appreciate and are grateful for each day. I restarted one of these in April and reading through it always makes me smile! Things I’ve written about include being thankful for my health, my (wonderful) Healthassist team, and the peaceful protests that continue to raise awareness of the inequities in our world. But I’ve written as well about simple things, such as the color of a bird or a flower seen on a walk. Overall, a gratitude journal can provide a boost in mood and help to restructure negative thoughts.

Regarding advanced life planning

The pandemic has created greater opportunity and need for discussions regarding life planning documents. If you don’t have any of these in place, start with the easy ones.

You can download a HIPAA release form and a Health Care Proxy online (for free) and complete these yourself. Then consider seeking out the services of an attorney and your physician for those documents that are more involved. The important thing is to get started!!

Regarding insurance

In the event you experience any symptoms of COVID-19 that require testing and any form of outpatient or in-patient care, please keep very careful records of dates of service, care you received, and calls made to your insurance company (including what you were told and by whom). The variability of how insurers are dealing with these claims leads me to believe there will be confusion. Good recordkeeping will facilitate troubleshooting in the future.

Final Thoughts

As we approach the summer months and learn to live within the confines of this pandemic, I urge you to be conscientious about your choices so that you remain healthy and virus-free. Please continue to wash your hands frequently, try not to touch your face, physically distance and wear a mask to protect others and demonstrate leadership by modeling the way.

In the event you require healthcare, don’t hesitate to reach out to those who normally deliver it to you. Staying as healthy as you can is the greatest gift you can give yourself.

Making the Most of Virtual Physician Appointments

Over the past few months and in many ways, the world has changed significantly. No more so than when it comes to accessing the care and advice of the physicians upon whom we depend.

Today, nearly all non-essential appointments are occurring virtually, whether through some type of videoconferencing or via our old friend and standby, the telephone.

Early on, these did not often go well! While physicians and their respective teams were quite open to the transition, in most cases it was, to put it nicely, clunky.

That’s partly because prior to the pandemic, most physician practices’ internal systems had simply not kept pace with patients’ or physicians’ desires for virtual appointments or with the technology required to make these work smoothly. Unfortunately, and practically overnight, the desire turned into a need and physician offices were left scrambling.

The good news is that over even just the first couple of weeks, the experience improved considerably. The bad news is that, like so many things in healthcare, there is no standard protocol, so every experience is different. Some sessions were initiated via text, some through the Patient Portal, still others required the advance completion of long questionnaires.

I have no doubt that post-pandemic, this will remain our “new normal” for many types of nonurgent visits. With that in mind, I want to share some suggestions for making these as productive and satisfying as possible.

Preparation is Key

I have always been a big believer in the importance of preparing for any physician appointment. Preparation helps to ensure that all relevant information is shared and that important questions are asked and answered.

This strategy holds true for virtual appointments as well. In addition, virtual calls require that further steps be taken to streamline the experience. Here are our suggestions:

Assess your technological capability and equipment. Do you only have a phone or smartphone (i.e., no computer)? If you have a computer, does it have a webcam? Do you know how to download software applications that may be required to make videoconferencing work? Speak with your physician’s office to determine what type of technology will be needed.

Enroll in your physician’s Patient Portal.Communication is much more efficient with the use of this secure technology. This is also where additional education material may be shared after your appointments.

Get set up ahead of time. Waiting until the time of your appointment to log in can lead to delays and frustration. Ask for specifics about the appointment log-in process (web site address, software required, phone numbers if needed) and see if you can practice connecting in advance. Make sure to understand how you would include any loved ones who you may want present as well. Outline a back-up plan in case the technology does not work on the day of your appointment.

Confirm a few days in advance. Physician offices continue to evolve the processes and technology used in virtual meetings. Check in a few days before your appointment to make sure the instructions you were given still apply.

Prepare your written agenda. Share it in advance via email or the Patient Portal. If you have the ability to take any of your own vital signs (temperature, blood pressure, pulse, weight and O2 saturation level), include that data with your agenda. Then, have it in front of you for the meeting to help guide the discussion and to take notes.

Follow-up. Summarize and document the appointment and any next steps, especially if follow-up is needed to schedule diagnostic testing. The physician will be documenting but you should as well, to make sure that nothing falls through the cracks. Contact the office to confirm how your appointment will be billed so that you are aware of applicable co-pays and co-insurance amounts

Two Additional Pieces of Advice

A physician friend shared these two things:

#1. Obtain care if you feel you need it.

An unintended consequence of the pandemic is that individuals do not seek care for emergencies (e.g., strokes, heart attack) at the same rate as before, whether out of fear of COVID-19 exposure or a perception that resources are not available.

Please do not delay emergency care; the capacity is there to treat you safely. In addition, if your physician feels you need an in-person visit outside of the emergency room, arrangements will be made to do so safely as well.

#2. Update your health care proxy .

We covered this in last month’s newsletter. Apparently, a tremendous amount of time has been wasted during hospital admissions trying to clarify who someone’s health care proxy is.

Final Thoughts

Telemedicine is here to stay. My physician friend expects that half of future visits will remain this way post-pandemic. She believes that this is an effective and comprehensive means of providing care for many patients under many circumstances.

So, let’s do what we can now to get used to this new world. As always, it is up to us, as healthcare consumers, to play a proactive role in ensuring a productive and satisfying experience.

Recommended Reading: Preparing for Telemedicine Appointments

This local institution had already been using Open Notes to document and share physician notes with patients. Now, they have taken it a step further with a wonderful project to help patients prepare for telemedicine appointments. Read more here.


Surgeon and best-selling author Atul Gawande offers lessons for re-opening from places that never locked down to begin with: hospitals.

His four-point approach is a “combination therapy,” and includes elements with which we are all familiar: hygiene measures, screening, distancing and masks. Culture is the fifth (and arguably the most difficult) pillar of a new combination therapy to stop the coronavirus.


Those who overcome adversity understand that while there is a lot they cannot control, they can — and should — pay attention disproportionately to those things within their area of influence.

Learn more in this terrific interview with Angela Duckworth , author of “Grit.”