UCSF Division of Geriatrics Weekly Updates (4/3/2020) from Chief Dr. Louise Walter
It’s hard to believe we are reaching the end of our third week of sheltering-in-place. This is the third Geriatrics Division Weekly Update to keep everyone more informed about what is happening across the Division. Though we are far from out of the woods, none of our hospitals in San Francisco are currently overstretched. The number of COVID-19 cases in CA is expected to peak ~ 4/26 (see link https://covid19.healthdata.org/projections). Thanks for all you are doing as we prepare for the worst but hope for the best. Below is a summary of the updates that have been shared with me this past week.
UPDATES ACROSS THE DIVISION
UCSF outpatient programs: We continue to admit patients to Care at Home using telemedicine visits. We also are conducting COVID-19 testing in the home. Care at Home and the UCSF Center for Geriatric Care (UCGC) continue to grow our clinical collaborations. Leah Witt gave a presentation to the UCSF Pulmonary Division this week and continues to bring principles of geriatrics to chronic lung disease.
UCSF inpatient Programs: Our Mobile ACE continues to provide Geriatrics Consultations for all adults age 80 and older on all units of Moffitt-Long hospital. Candace Kim and Todd James worked to update the UCSF Adult Inpatient Clinical Management Guidelines to include sections on Ethics, Geriatrics, and Delirium prevention. This is the UCSF framework for the clinical management of adults hospitalized with COVID-19. Our inpatient workforce is healthy.
San Francisco VA: The VA is engaged in surge planning and disseminating policies in case SFVA finds itself in a scare resource situation. Eric Widera and Kathryn Eubank are presenting Internal Medicine Residency Noon Conference on Friday 4/3, noon-1pm on “Rationing of Life Sustaining Treatments: A Discussion of Ethical Principles and the SFVA Policy.” The link to hear their presentation is https://ucsf.zoom.us/j/398129795. Also, Eric Widera has created Advance Care Planning Communication Guides encouraging increased ACP and goals of care discussions across settings of care using Rebecca Sudore’s PREPARE program (see email from Eric on 4/1/20 for these Guides). Theresa Allison has been training Home Based Primary Care and other VA clinicians to use VA Video Connect (VVC) for telemedicine visits. Contact [email protected] if you have VVC questions or want a link to her Tuesday/Friday Skype VVC office hours. Our Community Living Center (CLC) has no COVID-19 cases and is prepared to accept 6-10 patients in one wing of the CLC to off-load the hospital if necessary during a surge.
ZSFG: All specialty care clinics, including Geriatrics, have transitioned to telephone visits. The ACE Unit remains open and busy caring for non-COVID elders at ZSFG.
EDUCATION: Fellows’ clinics continue via telemedicine and all our didactic learning continues on Zoom. First-, Second- and Third-year medical students have now been sent home and continue remote learning on Zoom. Fourth-year students remain part of the clinical workforce. MS1 Hope Schwartz ([email protected]) is leading the UCSF COVID Student Aid Working Group and is the contact for front line faculty who are in need of assistance with tasks that enable them to focus on taking care of patients.
RESEARCH: The National Pepper Center Meeting is being held virtually 4/2-4/3 and highlighted several UCSF Pepper Center researchers. Scott Bauer was featured for his outstanding junior faculty abstract and Liz Whitlock was featured for her best Pepper Center Paper of the Year. Carla Perissinotto and Ashwin Kotwal will be starting their study of the impact on well-being and whether needs of elders in SF are being met during this time of social distancing. UCSF pharmacy and medical students contacted them and are volunteering their help to call elders in SF. UCSF students are so great!
GWEP: Anna Chodos is giving talks and Q&A to a senior group, Senior Power, fostering neighborhood connections between older adults in the Outer Sunset as part of the Community Living Campaign. Her talks, named “Dr. Chodos’ Chats,” are on Fridays at noon https://sfcommunityliving.org/.
POLICY: The Division of Geriatrics sent a letter to UCSF Health System Leaders offering our help and suggestions for where geriatrics expertise could be particularly helpful during this pandemic. The greatest risks of hospitalization, respiratory decompensation and death from COVID-19 are to people ages 80 and older, with those ages 60-79 also at elevated risk.
STAFF: All Division staff continue working from home unless they are providing direct patient care. Telework agreements currently due to expire 4/15 are now extended through 5/1 at least. UCSF has instituted an organization-wide grace period for Vacation Leave/PTO accrual maximums effective April 2020. UCSF employees that are at or close to their Vacation Leave/PTO accrual maximum will continue to accrue vacation above the maximum without losing hours for the next 4 months. If you have any staffing needs or concerns that you may run out of work for your staff due to the mandatory shelter-in-place order (which has been extended through May 1st), please reach out to Karen or Maxine who can guide you on what options are available.
CLINICAL UPDATES FROM OUR HEALTH SYSTEMS
San Francisco VA: 2 hospitalized cases of COVID-19 at SFVAMC.
UCSF Health: 16 hospitalized cases at UCSF; https://coronavirus.ucsf.edu/
ZSFG: 18 hospitalized cases at ZSFG.
SF Chronicle COVID-19 Dashboard (CA, County and SF#s)
OPTIONAL WEEKLY GERIATRICS DIVISION CHECK-INS
We will continue our optional division-wide check-ins.
Next Check-In Meeting: Wednesday April 8th from 2:30-3:30pm on Zoom
Future meetings will be April 15th and April 22nd at same time.
Next Geriatrics Half-Day is April 29th.
MAXINE’S WEEKLY TIPS
- Remember to make time for self-care including Weekly Mindfulness Meditation Sessions. Please join Amy Hephner, MPH on Wednesdays from 12:30-1pm for weekly mindfulness meditation on-line sessions. Sessions may include a mindfulness topic, reflection, meditation, or mindful movement. Each session is different and does not require experience or prior attendance. If possible, find a quieter space when joining. https://ucsf.zoom.us/j/514447417 Meeting ID: 514 447 417 Telephone: US: +1 669 900 6833 or +1 346 248 7799 or +1 646 558 8656 or +1 253 215 8782 or +1 301 715 8592 or +1 312 626 6799; iPhone single-tap (US Toll): +16699006833,,514447417# or +13462487799,,514447417#
- The Department of Medicine has created a webpage on childcare options: https://dom.ucsf.edu/covid19resources#Family-Care
STOCK UP ON COMPASSION
I encourage everyone to reach out to someone in our Division to ask how they are coping and share a kind thought. If you are at UCSF, you can use this link to express your gratitude to someone who has been helpful to you. At any location you can send an email, text of or call letting someone know you are grateful for what they are doing. This is an important time for kindness and compassion for ourselves and others. Also, please reach out if you need support.
RESOURCES ABOUT COVID-19 AND ELDERS
Sarah Ngo has updated our Division COVID 19 Resources document to include volunteer opportunities. She is also adapting our a COVID 19 Resources for Older Adults webpage to show our Division’s response to COVID-19. Please send her both patient/caregiver- and clinician-facing resources that you or others in the Division have developed.
If you have other suggestions for maintaining our social connectedness during this time, please email me. Thanks for all you are doing!
Louise
PS: Kathryn Eubank shared this link to a YouTube video making fun of video-conferences which I hope you enjoy too: https://www.youtube.com/watch?v=DYu_bGbZiiQ&feature=youtu.be