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POLST and Advance Care Directives for End of Life Care

It can be an uncomfortable and challenging topic – which is why preparing for the end of one’s life is often an avoided task. However, not being prepared for such a situation can be disadvantageous to patients and their families. This is why Dr. Michael Demoratz, National Clinical Director for Amada Senior Care, focuses on educating families about the importance of Advance Care Planning.

“If you deal with some of these issues before they become a crisis, they’re easier to handle,” Dr. Demoratz said.

Currently, only 25 percent of Americans have recorded their end-of-life medical wishes in a legal document. The problem with this is that more than half of patients are unable to participate in end-of-life decisions when they need to be made. In our healthcare system, the default decision in a medical situation where the patient is unable to make a decision is to treat aggressively. This may not follow the wishes of the patient, but without the proper documentation, doctors have no way of knowing that.

Some seniors may shy away from Advance Care Planning because they think it is a complicated legal process that has to involve a lawyer. In reality, there are only two forms to be considered, both of which can be completed by a healthcare professional – an Advance Health Care Directive and Physician Orders for Life-Sustaining Treatment (POLST).

An Advance Directive is for anyone 18 or older. This form provides general information and instructions for future treatment. It can also serve as a power of attorney for healthcare, and can allow a person to appoint an agent on their behalf. When it comes to Advance Care Planning, filling out an Advance Directive is the first step a person should take.

An Advance Directive will ask an individual to address whether they want to accept or refuse life-saving treatments such as CPR, breathing machines, and feeding tubes. It also allows a person to detail whether they’d like to receive pain medications and whether they prefer to donate organs or tissues. It’s important to remember that doctors’ power is limited – normally, they can offer guidance and lay out options, but they cannot make crucial decisions about treatment. If a patient is unable to make a decision at the time of treatment, an Advance Directive gives the doctor a road map that allows them to know the patient’s wishes and who to talk to about treatment decisions.

When appointing an agent, it is important that a person consider someone with whom they have a close relationship, though not necessarily a family member. The agent needs to know the patient’s values and belief. They should be able to handle the situation and make decisions when the time comes. Generally, it is best to name just one person, and to provide a backup if one wishes to do so. This person will act for the patient, consulting with doctors and making decisions about treatment in accordance with the patient’s wishes. Usually, this person steps in when the patient is no longer able to make decisions due to medical conditions (such as unconsciousness or dementia), but he or she can step in at any time the patient wishes.

The POLST form is fairly similar to an Advance Directive, except it is only for those who are seriously ill at any age. It acts as a guide for the treatment a patient is currently receiving for their illness. It also addresses questions about the types of life-sustaining treatments a person does or does not want to receive. POLST does not replace the Advance Directive, but rather translates it into medical orders when a person is seriously ill.

Below is a simplified list of the differences between an Advance Directive and POLST, provided by polst.org.

ADVANCE DIRECTIVE

• For anyone 18 and older
• Provides instructions for future treatment
• Appoints a Health Care Representative
• Does not guide Emergency Medical Personnel
• Guides inpatient treatment decisions when made available

POLST

• For persons with serious illness — at any age
• Provides medical orders for current treatment
• Guides actions by Emergency Medical Personnel when made available
• Guides inpatient treatment decisions when made available

Another thing to consider in advance care planning is palliative care. Palliative care usually takes place in the setting where care was first administered, such as a hospital or nursing home. Palliative care can begin at any stage of illness, meaning a person does not have to be considered terminal. It is meant to comfort the patient, but can be combined with other treatments to prolong their life. When it comes to end-of-life care, hospice is generally the most recognizable type of palliative care.

Hospice is palliative care with specific guidelines. To qualify for hospice care, a doctor must sign-off that a patient has less than six months to live. Hospice care can be covered by insurance, but may not be due to policy limits and other variables. Medicare also covers hospice. While there are hospice facilities, 85 percent of hospice care is administered in the home. One of the main differences with hospice care is that it focuses on comfort rather than aggressive treatments for the illness. Hospice caregivers want to give the patient the best quality of life for the time he or she has left, which usually means avoiding life-prolonging treatments. Hospice workers try to care not only for the physical needs, but the emotional and spiritual needs of the patient as well.

Hospice care usually consists of having a caregiver in the home with the patient. In nonmedical situations, Amada Senior Care caregivers help hospice patients with activities of daily living, and provide comfort in their last days of life. Amada Senior Care also provides assistance to families of patients receiving palliative care who want to relocate their loved one to an assisted-living facility or care home. With resources like amadaplacements.com, Amada professionals work to find the best possible facility that fits the needs of your loved one.

Written by Taylor French, Amada Contributor.

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