In the prior post, Nancy described detection devices to prevent or report falls. I didn’t intend to write such a distressing follow up, but life has a way of bringing things up, whether we want to think about them or not. Recently, someone close to me fell and had seizures and a stroke. He got to the hospital, but he was unconscious. There was no one available to describe what he wanted the doctor to do in the case he could not breathe or his heart stopped. I am pretty sure he would not want to live unable to feed or take care of himself. But what were his wishes? I’m not really sure, and he could not say.
This incident made it very clear to me that every one of us needs a discussion with our physician about what we would want if we are unconscious and unable to speak for ourselves. There are several forms that should be discussed and put on file BEFORE you need them. One is a Do Not Resuscitate (DNR) order. If you fall, are not breathing and have no pulse, do you want the medics to treat you with CPR (cardiopulmonary resuscitation)? You may or you may not. It is your choice. A DNR does not explain to medical professionals about any of the subtleties of end of life care, and it does not mean “do not treat”. It simply addresses whether or not you want CPR.
A POLST is more helpful and descriptive. It is a one page document that describes a longer conversation between a physician and a patient about end of life care. It is broader than a DNR (but it includes a box to check for DNR) and outlines the patient’s desires regarding the level of care — comfort care, limited treatment, or full treatment. A POLST is a medical order that can be used by emergency medical personnel in any setting – a home, a nursing home, a hospital – but it must be discussed and signed BEFORE the patient is unconscious. The rules about POLST forms may vary from state to state, so check your state out and if you live in two different places, you may need one for each residence. (Here is a sample POLST from Harvard Health and some FAQs about who needs a POLST.)
What about an Advance Directive or Living Will? An Advance Directive is a legal document that describes the type of care you would want in an end of life setting. It may include a DNR and a POLST, as well as a living will. Obviously, all of these documents should be created while the patient is fully able to discuss the issues.
If you are reading this and do not have these documents on file, talk this over with your doctor right away. Whatever your age, you owe it to yourself and your family to make these very hard decisions a bit easier to make! And be sure that these documents are easily accessible, especially if you live alone. Some emergency personnel suggest putting the POLST or DNR on the refrigerator so that the paramedics can easily find it. (See comments for other suggestions about how and where to keep it handy.)
In the case of my friend, he recovered consciousness within a few hours and was able to take over the decisions related to his own care.
As always, we welcome your thoughts and experiences!
I also found this very helpful FAQ about who needs a POLST. This document suggests that people in their 60s would not need a POLST. Only if they were quite frail or had serious disease. Otherwise, an Advance Directive would suffice. Do read this. It clarifies a lot of questions you might have.
http://www.polst.org/wp-content/uploads/2016/04/2016.04.03-POLST-FAQs.pdf
As I dug into this today, it seems that each state has its own version of the form (someone please check me on that!), so if one moves, gotta remember to update it. If one spends time in more than one state (like some snowbirds), it’s probably good to have one in each place. Do folks agree with that approach?
Apparently the POLST rules do vary somewhat by State. Here is a website that you can check to see what your state requires. I would imagine that if you live in two different states during a given year, you would want one in each residence. Also, although this website says a POLST is mainly for people in the last year of their lives, it should apply to anyone who could become unconscious and not have instructions about the treatment they would want. An Advance Directive is also a good choice for anyone.
https://www.everplans.com/articles/state-by-state-polst-forms
Hi Linda,
Really important information. Thanks Linda.
I have heard that some EMTs are instructed to look inside a person’s refrigerator for a POLST (also known and a MOLST — Medically Ordered Life Sustaining Treatment). The reason is that many of us would not like to have that chartreuse green POLST posted on our fridge for all to see. But we want the EMTs to find it. I think it’s useful to find out what the EMT’s in one’s area are instructed to do.
By the way, the best book I know of about end of life issues is The Art of Dying Well, by Katy Butler. She comes with a strong point of view — namely that commonly way too many procedures are done on the elderly that prolong their suffering. Her book has lots of practical, nitty-gritty advice about how to avoid that and get the care that will make your end of life as good as possible.
Great information, Fran! I have also heard that people put it in a plastic ziplock bag in the freezer! For us, our retirement center keeps it in the Wellness Center and the paramedics know that.
Thanks for the suggestion of the book. I will put it on our site in “news and views” for all to see.
After I wrote this, I went downstairs to the Wellness Center where my POLST is stored and re-read it. I changed the post a little, because the DNR is clearly there for someone who has NO pulse and is not breathing. It’s not just for someone who is having a heart attack but is still able to communicate somewhat. Because the POLST has a check box for DNR, they are not separate documents. And both of these issues can be dealt with in an Advance Directive. So I think you start with the Advance Directive and then fill out the POLST.
Here is a sample POLST from Harvard Health. Worth reading!!
https://www.health.harvard.edu/media/content/files/health-report-pdfs/Form%204_Sample%20POLST%20form.pdf
This comment comes from Ursula Kramer, who was not able to post this herself due to some technical issue with our Blog (please tell us if you have a similar experience!):
I enjoyed reading your article! How true this is,
especially for those of us, who unfortunately are living alone. I
have all the forms completed and in place and my POLST is taped
to my refrigerator for everyone to see. After being an Ombudsman
for so many years, and now having to resign due to my own illness, I
know how important these papers are. Also, I enjoy reading the
BLOG, good work. Many thanks. Ursula Kramer
Thanks, Linda! I consider myself very buttoned up on this sort of planning, but had never heard of a POLST before! Digging in on it now. Thanks for the info!
Thanks, Ed. Most younger people don’t know about POLSTs, and actually too few older people have one….but you just never know when you might need this kind of information on file. You can always change it if you want to, but at the very least it is there for guidance to medical professionals who might treat you. And for your loved ones? It’s important not to leave them without any guidance. The stress on families is significant.