Advance care planning is about preparing for the medical ‘what ifs’ that may occur throughout one’s life. It’s understanding the decisions that may need to be made, thinking those decisions through in advance and then communicating preferences to family members and healthcare providers.
Advance care planning isn’t just for old age. Anyone you love could have a medical crisis at any age that leaves them too ill to make their own health care decisions. Advance care planning allows your loved one to express their health care preferences and their medical care wishes to be followed if they become incapacitated or unable to communicate in the future.
There are many advance care planning topics you may wish to discuss with your loved one to help them create a comprehensive medical treatment plan for end of life.
Discuss your loved one’s wishes regarding medical treatment if they become severely ill or injured, suddenly in need of hospice or palliative care or unable to make their own health care decisions. These treatments could include:
• Do Not Resuscitate Order (DNR)
• Artificial hydration or nutrition
• Use of a respirator or ventilator
• Cardiopulmonary resuscitation (CPR)
• Kidney dialysis
• Comfort care
Make sure to hear any wishes concerning the procedures your loved one expects after their death and be sure these topics are recorded. These procedures could include:
• Organ donation
Once you have an understanding of your loved one’s medical care wishes, it’s important to document their preferences in writing.
An advance directive is a legal document that states your loved one’s wishes for medical care in an emergency and at the end of life. This document only takes effect if your loved one becomes unable to make medical decisions on their own.
There are two main elements in an advance directive—a living will and a durable power of attorney for health care. A living will is a legal document that specifies your loved one’s medical treatment wishes for end of life care and preferences for certain procedures after death, such as organ donation. The health care power of attorney is the person your loved one trusts to carry out their wishes.
Directives become especially important if your loved one does not want aggressive medical treatment. The default in our medical system is aggressive care, which will be used unless there is a clearly written advance directive in your loved one’s medical records.
In the case of an emergency, because a living will isn’t a medical order, it can’t tell emergency medical services (EMS) personnel or hospital staff what to do. Standard emergency medical protocols must be followed unless a doctor’s orders say otherwise. For this reason, your loved one should also consider having a POLST.
The Physician Orders for Life-Sustaining Treatment (POLST) and the Medical Orders for Life-Sustaining Treatment (MOLST) are the same thing, so we’ll use the term POLST from here on. The POLST is a doctor’s order, not a legal document. The POLST is for patients who are at the end stage of a serious life limiting illness. The form documents a patients’ decisions in a clear manner that can be quickly understood by all providers, including first responders and EMS. It helps give people with serious illnesses more control over their own care by specifying the types of medical treatment they want to receive during serious illness.
A POLST form is neither an advance directive nor a replacement for advance directives. An advance directive is used to appoint a legal Health Care Agent, and is recommended for all adults. A living will contains your loved one’s end of life preferences which are useful in non-emergency situations like in a hospital or skilled nursing facility. A POLST can work together with your advance directive, providing specific treatment wishes for immediate emergency care.
Many states have their own advance directive forms. You can get assistance in finding the appropriate forms from your local Area Agency on Aging or hire an elder law attorney to help. You can find your area agency phone number by calling the Eldercare Locator at 1-800-677-1116 or by visiting https://eldercare.acl.gov.
The POLST form is completed by a patient’s physician after thorough conversation with the patient regarding the patient’s current and future health conditions and treatment preferences. Both the physician and patient must sign the POLST.
As your loved ones’ decisions on how to carry out their advanced care plans could change at different life stages, you should revisit their plan as they age. Let’s hope they never have a medical situation where they are unable to speak for themselves, but having a plan in place can give everyone involved some peace of mind.
If you’re looking for more information on how best to help the aging loved ones in your life, contact the team at Oasis Senior Advisors. Call us at 475.619.4123 or 914.356.1901, or fill out our online form to get in touch with us today.