By Mark J. Bonamo 

Mary Donovick, geriatric and palliative care nurse practitioner at Saint Clare’s Health has both personally and professionally grown up at Saint’s Clare’s Health. It started when her mother, who worked at the hospital for 35 years, brought Mary to Bring-Your-Daughter-To-Work Day in the third grade. Now, as part of Saint Clare’s community-minded approach to patient care, Donovick defines her work as having two key elements.

“Geriatric and palliative care (symptom management) are very closely related. Both work with patients and/or their families to identify problems and help to manage them,” Donovick said. “It’s always our goal to manage symptoms, as well as improve quality of life, and to empower the patient to define what quality of life is for them. We are all born, and we are all going to die. Those are the two guarantees in life. It is a universal experience. A gift we can give to those receiving palliative care services is to give people choices who are near the end of life. We can give back power in the most powerless situation. We can help patients make choices that give them the best quality of life possible in a way that has the most meaning for them.”

As the American aging population is rapidly growing, there is an increased number of people living well into their 80s and 90s. With life being extended unprecedentedly, Donovick said there are some quality-of-life choices that patients can make that are relatively effortless.

“Annual wellness exams that are offered through Medicare is an important step in managing the senior population wellness care.  These wellness visits are comprehensive for both the seniors’ physical and psychological well-being,” Donovick said. “These exams address important reminders to seniors to stay safe, as well as active to the best of their ability.”

As seniors again, they often live with a measurable level of chronic illness, including heart disease, diabetes, hypertension, pulmonary disease, and cancer. Donovick emphasized that patients with these conditions should regularly follow up with their physicians and specialists, as well as maintain their prescription medication regimen.

“A serious concern in the senior population is forgetting why they are taking certain medications, or failing to report serious side effects. It is critical for them to have an open and honest dialogue with their provider,” Donovick said. “If seniors are having problems, the physicians or medical providers can work with the patient and prescribe alternative medications or recommend other therapies.”

COVID has had a negative effect on the care of seniors, including those important dialogues between patients and providers. However, Donovick pointed to two important fronts to focus on when providing care for seniors, particularly during the global pandemic.

The first front is physical well-being.

“Since the beginning of COVID, people have been afraid to schedule routine appointments with their healthcare provider or to seek treatment. Health care providers are taking every precaution to keep all patients, staff and physicians safe. Unfortunately, what has emerged is the growing number of advanced cases of a disease because seniors are too often afraid to seek the care they need and deserve., For example, we are seeing people seeking treatment much later than they previously would have and are being diagnosed with a late stage illness” stated Donovick.  We must encourage seniors to continue to see their providers for routine and problem visits in a timely manner.

The second front is psychological.

“Social interaction and family involvement is critically important to the overall wellness of seniors. Isolation and depression go hand-in-hand. Seniors are often very isolated, and COVID has deepened that divide. We have to keep a balance between working against isolation and keeping people safe,” Donovick said. “We have to teach our seniors the benefits and the use of technology, such as Zoom and FaceTime, which provided additional opportunities to socially connect. Social distancing and the increased numbers of vaccinated seniors has played a significant role in boosting social interactions and family involvement in seniors’ lives.”

“The advice that I share with family members who are caring for or who are responsible for an aging family member is to visit them,” Donovick added. “You should always take COVID into consideration, as well as preventative and precautionary measures, such as masking and social distancing as recommended. As COVID restrictions change, explore opportunities for increased social interaction, such as library church, or senior group programs, Anything you can do to help boost social interaction, which as human beings we all need, old or young, sick or healthy, will help immeasurably.”

At some point, we will all have to have a discussion with our families to plan for the end of life or for the unexpected. While these type of talks can be awkward or difficult, Donovick instead advocates a quiet revolution revolving around how people see these dialogues.

“We need to change our thinking that these discussions are end discussions. Instead, they should be seen as beginning discussions,” Donovick said. “Dying is scary, but so is living in pain or living a life in which the quality is greatly diminished. What is important to that person? What defines their quality of life? That definition is different for everyone. Quality of life is important, but what is also important is quality of death. What does a good death look like to someone? Do they have a preference for location? At home or in a hospice facility? Do they have a time at which they would stop all treatments and focus on comfort or do they want to continue with all treatments at all costs? What we can do is to help identify their goals and priorities, and then help people live and die based on what they have chosen.

“What do most people really want at the end? They want to be with their family. They want to be comfortable. They want love,” Donovick said. “These discussions should be with the people you trust the most, the people who would speak for you if you were no longer able to speak for yourself. These conversations should be put in writing in the form of an advanced directive or living will and specifically name your healthcare proxy or the person you have decided should speak for you. You should include what you would and would not want in your medical care, such as long-term tube feedings or ventilator support. You can also include other things that may be important to you, for example, what kind of songs should be played at a memorial service. These talks don’t have to be scary and once the ball is rolling often have people talking about the good times in their lives together. Consider these discussions a gift that you are giving your family. After having these talks, family members will not be left wondering if they honored their loved ones wishes.”

Donovick chose to work in the hospital in which she grew up. That dedication to community is part of Saint Clare’s Health core beliefs and part of her dedication as well. For Donovick, doing her job with dignity and respect for all patients at Saint Clare’s is not just doing the right thing. In the context of her entire life, it is the only way to care for others. 

“I take care of friends and family, and I work next to friends and family. While you may be a number somewhere else, here at Saint Clare’s Health, we know your name. We really are a family,” Donovick said. “When COVID hit, we were taking care of our families, and we were taking care of each other like family. We know each other, we love each other, and we care about each other. I adore my patients. I feel blessed every day that I get to do the job that I do, because I get to give back.”

“My dad died unexpectedly about five years ago. I do what I do because I get to give opportunities back to people that I did not have with my own dad. Every day when I’m doing my work, I feel like I get to speak to him, and to do the things for others that I wish someone could’ve done for him,” Donovick said. “It’s a tremendous gift.” 

Saint Clare’s Health offers inpatient geriatric and palliative support. They also have a Nationally Accredited and Recognized Senior Emergency Department, as well as provide convenient senior transportation services.  For more information on palliative or senior services, contact Mary Donovick at 973-983-5755.