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POLST helps with hard decisions

New form makes planning for end-of-life medical care easier and more comfortable

Posted: November 22, 2009 9:32 p.m.
Updated: November 23, 2009 4:55 a.m.

From left to right, Santa Clarita Valley Senior Center Supportive Services Care Managers Michelle Cornell and Karin Kelly, Marlene V. Harrison, a registered nurse with Concepts for Living (a free residential placement service for seniors) and Senior Center Supportive Services Director SuzAnn Nelsen discuss the POLST form and its benefits.

Planning ahead for one's end-of-life medical care is generally not a topic people look forward to discussing.

Many avoid it altogether. And that can be extremely problematic, even tragic.

To ensure a patient's feelings about life-saving and sustaining treatments - such as cardiopulmonary resuscitation, intravenous fluids, wound care, use of oxygen or antibiotics or tube feedings - pre-need decision-making and documentation are crucial.

A new form, "Physician Orders for Life-Sustaining Treatment," or "POLST," streamlines this instructive process. A bright pink, double-sided single page physician's order, POLST lists succinct instructions about a patient's medical conditions and what they want (or don't want) in the last stages of life.

At a recent Tri-Valleys Aging Network gathering, Geriatrician Sabita Malla, M.D., Elder Law Attorney Jane M. McNamara and Anita Miller, a geriatric care manager with the Alzheimer's Association, discussed the benefits of POLST. The educational event was held at Sunrise at Sterling Canyon Senior Living in Valencia and included a luncheon and question-answer period.

POLST is strongly recommended for the elderly and anyone with a terminal condition (considered to have six months or less to live), Anita Miller said.

The condensed treatment order form remains with the patient, whether they are at home, in the hospital or in a long-term care facility. Further, if the patient lives at home, the original pink POLST form should be kept where emergency responders can easily find it, Miller emphasized.

Serving as "default orders," POLST helps apprise emergency personnel, technicians, doctors and nurses of the patient's wishes until further orders can be decided upon and written, said Malla, whose practice centers around caring for the elderly. She also stressed the importance of physicians periodically reviewing and updating POLST if their patient has been transferred to another facility, significant changes have developed in their health status, or one's wishes have changed.

The presence of this easy access medical information helps ensure that the patient's wishes are respected and strives to prevent mistakes from being made. (Example: wrongly implementing CPR and bringing a "do not resuscitate" patient back who was opposed to such measures being taken.) While completely voluntary by law, POLST fosters important discussion and decisions between patients and health care professionals, said Attorney Jane McNamara.

McNamara also noted that while California legislation for POLST went into effect on Jan. 1, its use is not mandated. However, by law all health care providers must honor patients' POLST orders.

The California Coalition for Compassionate Care is the statewide leader for implementation of POLST in California, but the form itself was designed in Oregon, well-known as an end-of-life advocacy state, McNamara added.

It is recommended that patients have Advance Healthcare Directives (AHCD) as well as POLST, Dr. Malla said, explaining that POLST reinforces wishes expressed in the AHCD. (Note: An AHCD is written instructions stating your desires for future medical decisions in the event you become unable to make or communicate those wishes for yourself. It includes who you want to make your health care decisions if you are unable to do so.)

The POLST informational gathering was one of numerous Tri-Valleys Aging Network's learning events held throughout the year.

"Representing the Santa Clarita, Antelope and San Fernando valleys, the network was founded to ensure networking and educational opportunities for professionals in the field of aging," said Tri-Valleys member Marlene V. Harrison, a registered nurse and Senior Care Coordinator with Concepts for Living, a free residential placement service for seniors.

Harrison noted that membership is open to a large cross section of elder-focused professionals.

That roster includes physicians, nurses, care managers, home health care providers, health insurance staff, senior centers staff, newspaper reporters, funeral industry representatives, durable medical equipment representatives, protective services, attorneys, and students majoring in areas affecting elders.

Karin Kelly, a registered nurse and Santa Clarita Valley Senior Center Supportive Services case manager, praised the Tri-Valleys presentation and hailed POLST as a "very good idea."

"It gives care managers the tools to help our clients by availing the form to them without their having to go to a physician. And while the document does have to be signed by the physician, it does not have to be notarized, so it's easier to complete and easier to access," Kelly said.

In addition to care managers, social workers, nurses and other healthcare professionals can help patients fill out the POLST form, but it must be reviewed and signed by the doctor. A health care representative (health care agent or surrogate) must also sign the form.

"POLST helps everyone involved with a patient's end-of-life care," said Senior Center Supportive Services Director SuzAnn Nelsen. "It gives patients the dignity of knowing their end-of-life care decisions will be honored and it affords medical professionals peace of mind knowing they carried out those wishes."

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