Not Another Acronym! But this is important end of life care information . . .

Whether aging or ill ourselves, or serving as advocate for our aging or ill loved one, it is important to stay abreast of what can be stipulated regarding health care.  A POLST  (Physicians Orders for Life Sustaining Treatment) is designed to instruct emergency personnel on what actions to take (or not take) while you're still at home or on the way to the hospital.

This article was contributed to The Vault by Mosaic Financial Partners, a Wealth Advisory Firm   

Addressing End of Life Care

When nearing the end of life, many people reach a point of wanting to avoid the extra procedures normally expected of emergency caregivers. A relatively new document called the Physicians Orders for Life Sustaining Treatment (“POLST”) can help you express your wishes in an accepted format, so that your wishes will be respected.

Until recently, an “Advance Directive” was the only accepted tool which a person could use to state wishes for the end of his or her life. An Advance Directive generally contains information about a person’s desire to be mechanically ventilated, artificially fed, and his/her desire for comfort care, for example, but it does little to protect a person from unwanted emergency medical care like CPR or transfer to a hospital. Separately a Do Not Resuscitate Order (DNR) can protect a patient from unwanted chest compressions, electrical shocks, and artificial breathing. End of life advocates realized that neither form addresses many of the emergency decisions.

With the use of a POLST form, emergency and medical personnel get from the patient clear orders regarding which actions to take in the event of an emergency. It includes the patient’s desire to have or refuse CPR, to be taken to a hospital, and whether to receive artificial nutrition. The POLST is part of the patient's permanent medical record, and transfers with the patient from facility-to-facility—at home, in a nursing home, a long-term care facility, and in the hospital.

States vary as to the form of the POLST document and other specifics but the general form is the same. Eleven states, including California,* have fully endorsed the program and about 20 others are developing the program. Anyone who has a chronic or life-limiting illness or anyone reaching advanced age should consider having a POLST document in addition to an Advance Directive and a DNR. The standard procedure is to print it out on brightly colored card stock (pink in California and most other states) and attach it to the outside of a patient’s refrigerator at home or put it in the freezer. Emergency personnel are taught to look for it there. Learn more at the POLST website at www.ohsu.edu/polst.

What does the POLST Include?

The POLST paradigm has three or four sections (depending on the state) in which a person can choose his or her desired medical intervention.  It may include "do not resuscitate" and "comfort measures only" orders, and it may indicate whether to administer CPR (cardio-pulmonary resuscitation), antibiotics, intravenous fluids, feeding tubes, artificial respiration, and other medical interventions. Unlike the advanced health care directive, the POLST governs medical issues that are considered very likely to arise in the near term, and therefore most suitable for those expecting to die within a year.

POLST versus an Advance Health Care Directive?

An Advance Health Care Directive is designed to give instructions on desired medical interventions once a person has already had emergency treatment – usually directed towards hospital or nursing home staff. The POLST is designed to instruct emergency personnel on what actions to take while you're still at home or on the way to the hospital.

Who Needs to Sign a POLST?

In all states where the POLST is accepted and legal, a patient or their legal healthcare decision maker needs to sign the form. A physician must also certify that the decision the patient is making is consistent with the patient’s current medical condition and that the patient knows what they've asked for. In some states, a nurse practitioner or a physician’s assistant may legally sign the form.

*Oregon also has an endorsed POLST program.

Source material for the article came from Oregon Health and Science University  www.ohsu.edu/polst/

This article republished with permission from Mosaic Financial Partners, a Wealth Advisory Firm and is not intended as legal or investment advice.

Mosaic Financial Partners offers you a personalized, creative approach with expert advice to help you meet your Financial Planning and Investment Management goals. With offices in San Francisco and Lafayette, Mosaic Financial Partners can be reached by email at [email protected] or visit their website at www.mosaicfp.com.

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