The California Department of Public Health issued an All Facilities Letter (AFL) providing guidance for confirming resident treatment wishes during the COVID-19 pandemic through proactive advance care planning. The letter emphasizes that skilled nursing facilities (SNFs) should confirm residents' treatment preferences, develop care plans, and obtain requisite orders reflecting residents' goals, values, and preferences. The AFL recommends that SNFs inform residents of their higher risk of severe illness and death from COVID-19, as well as possible treatment options. SNFs should also confirm residents' preferences for treatment in case of severe COVID-19 symptoms, review existing advance care planning documents, and create treatment plans reflecting resident preferences. For residents testing positive for COVID-19, SNFs should assess whether transfer to an acute care hospital is medically indicated and desired by the resident. The letter also encourages the development of telehealth programs to support advance care planning conversations and rapid virtual access for residents and families to community and hospice palliative care services.

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