As a top-rated elder law attorney serving Montgomery County, PA, I help families with Medicaid and estate planning, special needs planning and long term care planning. When I am assisting them with getting their affairs in order, clients often ask me whether they need a POLST if they have an advance directive.

Pennsylvania has a POLST form. POLST is known traditionally as physician orders for life-sustaining treatment. Currently, there is no requirement that a POLST form is used. A POLST form, which is filled out toward the end of life, helps ensure that patients will receive appropriate end-of-life care. It creates an actionable, transferable medical order to direct care and make it consistent with patients’ goals and preferences for care and treatment at the end of life. If, for example, a patient is admitted to a hospital from a nursing home, this form that can be transferred with the patient as they move between medical providers, such as. With a POLST, a patient gets options from a full variety of care packages, from limited comfort to aggressive care.

Under the Health Care Powers of Attorney, health care professionals can discuss options with seriously ill patients or their agents, record those preferences on a standardized medical form, and this guarantee that it travels with the patient. Since it’s an actionable medical order, it is distinct from a Living Will or health care power of attorney. You should still have healthcare power of attorney documents and a Living Will prepared in advance.

Although it is advised that all adults complete advance directives, consisting of a health care power of attorney and a living will, only about one-third of individuals have done so. Often, people have advance directives that were written decades ago and do not necessarily reflect their current wishes. POLST forms are an important tool for attaining patients’ care preferences.

The concept of a POLST being portable allows a person to have them readily available at all care settings, including at hospitals, retirement communities and nursing homes. POLST forms are designed for gravely ill or feeble individuals. POLST form orders are intended to be used in conjunction with an advance directive.

The National POLST Paradigm Characterizes These Individuals as Those:

• Whose health care professional would not be surprised if they died within 1-2 years;
• Who are at an increased risk of experiencing a medical emergency based on their current medical condition and who wish to make clear their treatment preferences, including about CPR, mechanical ventilation, ICU;
• Who have had multiple unplanned hospital admissions in the year, typically coupled with increasing frailty, decreasing function, and/or progressive weight loss.

Do I Need a POLST Form if I Have an Advance Directive?

POLST forms are sometimes confused with advance directives, but the two vary significantly. Advance directives consist of a living will and healthcare power of attorney) are safeguards that all adults, regardless of age, should have. An advance directive describes a legal document that you use to provide guidance about what types of treatments you may want to receive in case of a future, unknown medical emergency. Also, this document allows you to state who can speak on your behalf to make medical treatment decisions when are unable to speak for yourself.

By contrast, a POLST form is useful only near the end of life and addresses an individual’s current medical circumstances. An advance directive can be signed at any location. POLST forms are signed only at medical facilities by health care professionals. An advance directive and POLST work together. Again, all adults should have an advance directive, whereas a POLST should only be considered if one is diagnosed with a serious illness or frailty near the end of life.

What if I Do Not Have a POLST Form?

Without specific instructions regarding end-of-life care or a trusted individual who has been appointed as the decision-maker, patients are vulnerable to undesired and possibly aggressive care. For example, patients with late-stage cancer who can no longer articulate their wishes may be treated aggressively with a multitude of therapies, fed artificially, intubated and have their dying process prolonged despite their preference to receive comfort care only. Moreover, some patients may be deprived of desired life-extending treatments because doctors make assumptions that a patient with end-stage illness would not desire interventions.

Do POLST Forms Accurately Record Patients’ Wishes?

The POLST is designed to be simple and concise. The check-box format of POLST forms is subject to a lot of criticism. Critics do not like that there is not an area to include explanations related to various circumstances that may arise. For example, some patients may prefer comfort measures only at the end of life, however they may wish to have antibiotics or IV fluids if they contract an easily treatable infection months before they are expected to die. The POLST does not allow for a stipulation to be included.

Does the POLST Paradigm Adequately Promote and Safeguard a Patient’s Autonomy?

The POLST paradigm is intended to provide patient autonomy by offering patients the opportunity to have their health care preferences followed. Patient advocates and ethicists are concerned that patients do not always understand the POLST forms, content on the forms and the purpose of the POLST forms. Do POLST forms accurately convey patients’ wishes? It is important for patients to review their POLST forms periodically and make amendments when necessary.

More Research Is Necessary About Patient and Provider Understanding

Critics proclaim that there should be more oversight of the conversations between the healthcare providers and the patients when they are completing the POLST forms. Moreover, it is challenging to determine if the forms were signed without a thorough discussion about the patient’s wishes. The POLST paradigm does not require the patient’s primary care physician to discuss POLST with the patient or to sign the POLST form. A nurse practitioner or physician assistant can sign the form.

Sadly, however, these clinicians may not be as familiar with the patient as their primary care physician. Surprisingly, often nonmedical personnel often help patients with filling out the forms then a physician signs it. Then, the POLST form is included in the patient’s medical record. Medical providers need to be aware of the limitations with POLST forms. Meaningful conversations between a patient and their primary care physician will help the physician better understand the patient’s wishes and goals.

Benefits of a POLST Form

Despite some concerns, POLST has been proven to be useful. In many studies, the POLST form has been effective at significantly reducing unnecessary resuscitation and unnecessary hospital admissions. POLST portability is particularly valuable. It enables all medical facilities in which a patient is treated to learn of the patient’s wishes if he or she is unable to communicate them.

Additionally, studies verify the benefits of POLST. For example, a three-state study of 90 nursing homes displayed that people with a POLST form who indicated they wanted “comfort measures only” experienced a lower rate of hospitalizations.

Having a well-drafted estate plan by a trusted attorney is important in ensuring that you will receive care that you desire and that your wishes will be followed. If we can help you or your loved one with your elder law planning needs, contact Slutsky Elder Law today at (610) 940-0650.

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