When it comes to the final few years, months, weeks, or days of a senior's life, caregivers are often charged with making or helping to making some of the most challenging decisions of their lives. Among these is the decision to end or sustain the life of their loved one based on their loved one's wishes, and to find the legal pathways to do so. As discussed in previously published articles, obtaining power of attorney--the ability to make these types of decisions for a senior in one's care--can be a difficult legal process. Yet what happens when the worst suddenly becomes reality: how do a person and the senior in that person's care navigate the legal pathways and care decisions surrounding death and communicate those decisions to health care professionals for implementation?
Advanced Health Directives
One of the most protective documents in situations like the above is an Advanced Health Directive document, or AHD. In such a document the senior names who will assume the power of attorney and gives instructions for health care, donation of organs if so desired, and possibly also names a primary physician who will be the main advisor on healthcare matters and who also will coordinate the person's care. This document can be amended at any time. It is important for family members and/or caregivers to keep this important document handy when the elderly person in their care needs to go to the hospital or to stay in an extended care facility.
The document is intentionally broad in scope, which allows a senior and caregivers to tailor it to meet changing needs. Some people may have their AHD specifically state that, in the event of a coma or other such event, life-sustaining treatment is to be maintained for a certain number of days, weeks, months, or years; it can also state detailed instructions against resuscitation should a senior's heart stop during surgery. Seniors and family members should take time creating and discussing this document together, and, if possible, have a legal advisor present during finalization. Suddenly creating such a plan in the midst of an emergency is not wise. It could result in a senior getting unwanted care or missing out on care he or she wants. Planning ahead with this document and opening the discussion will yield the best results.
Suddenly creating a plan in the midst of an emergency is not wise. It could result in a senior getting unwanted care or missing out on care he or she wants.
It is normal to feel overwhelmed and emotional about the decisions inherent in creating an AHD. Talking with doctors, counselors, and legal advisors about all of the options is healthy and normal, and being troubled by the possibility of taking power of attorney is also common. It is a huge responsibility, and caregivers should be sure to express their anxieties, emotions, and concerns in healthy ways.
POLST Forms and the POLST Paradigm
POLST, or Physician/Practitioner Orders for Life-Sustaining Treatment forms are specifically created for seniors whose illnesses are severe, or who are extremely frail due to age or illness. These include physician-advised medical plans and treatments should health emergencies arise. It is seen by those who use it as a way to create a more complete and specific set of wishes than an AHD, especially because it outlines specific steps to be taken (or not to be taken) by physicians in case of likely healthcare crises. A POLST form does not replace an AHD; it supplements it.
There are a few things that a POLST cannot do, however. It cannot name power of attorney, and it cannot be done without the aid of a health care professional in charge of a senior's care. It also requires that health care professionals are trained in filling out such forms and helping seniors and their caregivers make these decisions. In order to properly complete a POLST form, both sides need to come to a consensus about what will and will not be done in the case of a healthcare emergency. This should be done while taking into account religious and other values and beliefs as well as the practical nature of a senior's health situation at the time of writing.
While AHDs are designed to let loved ones and physicians know general responses to healthcare situations, POLST forms are designed specifically for physicians and other healthcare professionals when seniors are making their final healthcare decisions. In each case, it is best to make these decisions before the situation is an emergency, rather than trying to react or cobble together a plan based on what caregivers think (but do not know) the loved one would want. Both of these tools can empower seniors and their caregivers to make informed, healthy choices instead of rash ones charged by emotion and clouded by misinformation or confusion. Having both, if the situation calls for it, is the best plan if a senior in one's care is nearing the end of life.
AARP.org. Advance Directive: Creating a Living Will and Health Care Power of Attorney. Available at http://www.aarp.org/relationships/caregiving-resource-center/info-11-2010/lfm_living_will_and_health_care_power_of_attorney.html. Retrieved June 20, 2016.
Mayo Clinic. Living wills and advance directives for medical decisions. Available at http://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/living-wills/art-20046303. Retrieved June 20, 2016.
National POLST Paradigm. What is POLST? Available at http://www.polst.org/about-the-national-polst-paradigm/what-is-polst/. Retrieved June 20, 2016.
New Jersey Hospital Association. POLST. Available at http://www.njha.com/quality-patient-safety/advanced-care-planning/polst/. Retrieved June 20, 2016.
Stanford University. Advance Health Care Directive Form Instructions. Available at https://med.stanford.edu/content/dam/sm/bioethics/documents/pdfs/Advanced.directive.CA.pdf. Retrieved June 20, 2016.
State of New Jersey Department of Health. Practitioner Orders for Life-Sustaining Treatment (POLST). Available at http://www.nj.gov/health/advancedirective/polst/. Retrieved June 20, 2016.
Wolf, R. B., Maag, M., and Gallant, K.B. (Spring 2014). The Physician Orders for Life-Sustaining Treatment (POLST) Coming Soon to a Health Care Community Near You. Real Property, Trust, and Estate Law Journal 49: 71-161. Available at http://www.upmc.com/Services/AgingInstitute/partnerships-and-collaborations/Documents/POLST%20ARTICLE.pdf. Retrieved June 20, 2016.