Why a POLST form is an essential tool for caregivers

If you provide long-term care for a loved one with a serious illness or condition, learn more about the Physician’s Orders for Life-Sustaining Treatment (POLST) form and how it can protect your loved one—and you.

As caregivers, we are so busy tending to our loved one’s quality of life from day to day that it’s often difficult to think about end-of-life issues. That was certainly true for me when my mother was living with advanced dementia in a nursing home.  As I’ll explain shortly, I thought I had everything in place to honor her preferences for her end of life, but protecting her from unnecessary medical intervention turned out to be more complicated, and traumatic, than I expected.

If your loved one already has a Health Care Proxy and Living Will, that’s terrific. You may also have asked their doctor to sign an “Out of Hospital Do Not Resuscitate” (DNR) order. But a 4thdocument, less well-known, is equally as important: the Physician’s Orders for Life- Sustaining Treatment (POLST) form (available in many, but not, all states; see below).

A neon-pink POLST form

Why do we need POLST forms?

First of all, neither Health Care Proxies nor Living Wills are honored by EMS crews in an emergency. A DNR form should be honored by EMS crews, by law, but a POLST form is neon pink, designed to grab the attention of EMS crews in a commanding kind of way. It’s also more detailed, and updated and signed by your loved one’s physician on a regular basis, so it carries more weight than these other forms with EMS crews, hospitals, and elder care facilities.

A POLST is for patients with serious health conditions who

  • Want to avoid or receive life-sustaining treatment
  • Reside in a long-term care facility or require long-term care services, or
  • Might die within the next year.

The POLST form details the patient’s preferences for:

  • Resuscitation instructions when the patient has no pulse and/or is not breathing
  • Instructions for intubation and mechanical ventilation when the patient has a pulse and the patient is breathing
  • Treatment guidelines
  • Future hospitalization and transfer
  • Artificially administered fluids and nutrition
  • Antibiotics, and
  • Other instructions about treatments not listed.

How are POLST forms Different From Living Wills?

Unlike a Living Will, which is generally completed once, a POLST form (in some states called a MOLST form, for Medical Orders for Life-Sustaining Treatment) can be updated as the patient’s condition changes, per the patient’s wishes, or, if the patient can no longer make medical decisions, per the caregiver’s understanding of their wishes.

The author’s mother, Judy

My mother’s POLST form offered some protection from unnecessary trips to the E.R., but I misunderstood one section. I had assumed that since my mother was on “comfort care only” in the last few months of her life that she would never be sent to the hospital. I was wrong. One night shortly before Mom died, the night nurse at her nursing home sent her to the E.R. at 3:00 in the morning because she had difficulty breathing. Instead of contacting the nursing home doctor in the middle of the night and starting comfort care measures such as morphine, the nurse called an ambulance. I didn’t see the nurse’s message on my cell phone until 8 a.m., so by then Mom had been subjected to a battery of tests all alone. I managed to have her transferred back to the nursing home, but her vital signs plummeted before the morphine kicked in to relieve her discomfort. She passed away 3 days later from heart failure after much unnecessary trauma.

As I suggested to the nursing home’s director a few weeks after Mom died, it might have been a good idea for the staff to go over the POLST form with me during one of the many care plan meetings I attended.  In hindsight, I realize that I should have talked with the staff about what can be done for comfort care in a nursing home, and what might require a hospital visit.

As family caregivers, we need encouragement to talk about end-of-life issues. We don’t always understand what different terms mean, and we need clear communication with doctors and facility staff. The POLST serves as a valuable tool to begin that conversation, protect our loved one’s wishes as best we can, and support ourselves as caregivers when we are faced with very difficult decisions.

To find out if there is a POLST (or MOLST) form provided by your state, visit the Physician’s Orders for Life-Sustaining Treatment website.

Reprinted from Caregivers.com