Advance Directive and POLST – Helping Your Parents to Help You

Is your mother elderly, you are the one who likely will be the caregiver if she needs help, and she has no Advance Directive or POLST? Do you even know her end-of-life wishes? If not, you are not alone; that’s not the kind of conversations most of us have with our aging parents – albeit, it should be. I was talking with a woman recently who’s mother, a proud, fiercely independent woman, suddenly had a stroke and lost, not only her ability to live independently, but her ability to speak. Her mother always said she would take care of herself and didn’t want her daughter to worry herself; she refused to talk about it. The daughter, during this emotionally trying time, had to figure out how to navigate the legal jungle to become the power of attorney (POA of healthcare); the legal role necessary to make the medical decisions. Then she was left to make decisions about her mother’s care, and later, her end-of-life choices; she could only guess and her siblings had other ideas. This added undue stress to an already difficult role of being the caregiver!

Have that difficult discussion NOW! And complete and file the Advance Directive and the relative new document: the POLST. This Physician’s Orders for Life Sustaining Treatment ensures that one’s wishes defined in the Advance Directive will be followed by all medical personnel including EMT, emergency room doctors out of your home area, even your own doctor. I’m sure you have heard stories, as have I, that requests in the Advance Directive were ignored by well-intending medical providers who thought differently. The POLST provides clear orders about medical interventions you want or do not want: 1. CPR or not (known as DNR for “do not resuscitate”); 2. Degree of medical treatment: comfort only – relief of pain and suffering; limited intervention only - pain relief and IVs for fluids and antibiotics, if needed; or, full medical care as needed, including hospitalization and intensive care. Additional details can be written in if the patient and doctor see fit. 3. Your wishes about the use of feeding tubes: none; short-term through NG tube (in the nose); or if necessary, a
gastric tube inserted into the stomach for long-term feeding.

The POLST form must be signed by the individual (your parent) or legally recognized decision maker (spouse or POA), and by the physician. It then is filed in the medical record. If you have a chronic or life-limiting illnesses or are elderly file copies in your living will or trust at home and with family members in case of emergencies where EMTs are involved.

As of the end of 2011 there were fifteen states with POLST programs and about 20 states in the process of developing programs. The POLST form carries no legal weight in states without a POLST program. Check online at www.POLST.com to see if your state is included and download a form.

And while you are at it, complete your own Advance Directive (you never know when something bad will happen to a good person); your children will thank you. Download forms at: www.caringinfo.com. Or better, spend a little time with an elder law attorney.