Comment on: Coronavirus 2019 in Geriatrics and Long-Term Care: The ABCDs of COVID-19.

To the Editor:

I applaud Drs D'Adamo, Yoshikawa, and Ouslander's excellent article on the ABCDs of managing the coronavirus disease 2019 (COVID‐19) epidemic in long‐term care.1 A critically important decision that requires additional examination is transferring a resident to a hospital. Clinicians and nursing staff must be prepared to engage in a forthright discussion about the risks and benefits of a hospital transfer. I am especially concerned for those residents with advanced dementia, who likely will not benefit from hospital transfers. Simply obtaining a code status and writing do not resuscitate orders are not enough because it only addresses the care that is not going to be provided. Instead, proxy decision makers should be offered a meaningful alternative, which I call intensive individualized comfort care (IICC).2 IICC is a mode of care in which the entire healthcare team works together to ensure that residents are comfortable and have the best quality of life for as long as possible. Figure 1 provides an example of how to talk with proxy decision makers about IICC.

Figure 1

Sample script to talk about intensive individualized comfort care (IICC). DNR, do not resuscitate.

COVID‐19 is a natural disaster, a major catastrophe, and a world crisis. It has produced a race to contain the spread, an amassment of ventilators, and a surge in intensive care unit (ICU) beds. All are critically important. However, in our haste to contain, amass, and surge, let us not forget that we must also relieve, treat, comfort, and support. We must provide an alternative to invasive, ineffective treatments. We must educate staff, stockpile medications for symptom control, and provide training in counseling and symptom management protocols. IICC is not abandonment. It is not hastening death. It affirms life and is care patients and families want. It is as critical during this time of crisis as are masks and gowns, ventilators, and ICUs.