COVID Emergency Highlights Importance of POLST

One of the most heartbreaking things about this emergency is the prohibition of in person visitation of loved ones who were already declining in facilities.  Communication with facilities is less than ideal.  Now, more than ever, healthcare workers need to know where legal decision-makers stand on treatments and possible interventions, because one never knows when COVID-19 will take hold.

The Practitioner Order for Life Sustaining Treatment (POLST) is a universal doctor’s order that lays out what treatments and interventions are permitted for a person in the last years of his or her life. It is signed by the individual or his or her legal representative, and the physician, nurse practitioner or physician’s assistant.  It can be filled out and signed over the phone.  It can be updated.  The most recent POLST always controls.  POLST is designed to follow the resident to any subsequent setting, such as a hospital, or hospice.

Of course, the first step of all of this is to determine the resident’s competence to sign a POLST, and subsequently, if the resident is not competent, to determine who the legal medical decision-maker is. The social service department should conduct a telephone conference with the decision-maker to make, reconfirm or update the POLST.

These issues are upsetting and difficult but we’re here to help. Call 732-382-6070 and ask for a  telephone consult.



Planning for Later

A long-term client of mine called to tell me that he had just learned that he had a terminal illness – it was a medical problem that appeared suddenly appeared. He was about 70 and his wife about the same. Their children were self-supporting adults, out of the house. Both he and his wife were retired – he was collecting Social Security and a pension. He had always handled the family finances. The house was paid off. His wife had a lot of local friends and many volunteer activities that she enjoyed. She was frantic and had become depressed, as she couldn’t stop thinking about the space in her future that would be so empty and how she would manage things. She was paralyzed with fright. When she thought about the future, all she could see was jumbled chaos.

The husband brought his wife with him to meet with me. We talked about the survivor’s benefit on his pension and the bump-up in Social Security that she would receive. We looked over the assets and showed her how they would transition to her ownership and would not be lost. We sketched out a plan of steps to be taken “when the time comes,”  and we reviewed and updated their powers of attorney, health care proxies and Wills. We talked about ways she could keep him comfortable at home at the end, and what benefits could help with that. We discussed hospice and when it would make sense to bring in that support. The husband dictated his wishes for his funeral arrangements, which were typed up for his signature. We also mapped out the budget  so that his wife could see that she could comfortably remain in the house “afterwards.”

By focusing on a set of specific decisions and steps in an orderly way, my client’s wife became less afraid for her future. Sad, yes, but less afraid and less worried. She felt more confident that as they began moving through this terrible transition, she would have a framework for decisions and would know how to approach each decision as it became necessary.

Careful planning can prevent a crisis. Call us for advice on elder care and end of life planning….. 732-382-6070

What is Hospice care all about, really?

Palliative care is a specialized team approach to helping a patient to cope with the debilitating symptoms of certain serious complicated illnesses such as parkinsons Disease, heart failure, kidney failure, or COPD. The patient is receiving curative treatment and emergency room care during acute episodes of illness, and can receive dietary support, pain management, grief counselling, massage and other forms of care from the palliative care team of health professionals. This can greatly improve the patient’s ability to cope with the symptoms of their illness.

Palliative care services are generally provided at the bedside in a hospital or skilled care facility (nursing home or rehabilitation center) and can still be covered by certain health insurance programs such as Medicare. That would include room and board under Medicare part A . Of course each insurance plan has to be scrutinized to verify the coverage.

Hospice care is sometimes referred to as “palliative care,” but is really something different. It is an alternative to curative treatment,  for a patient who no longer wants medical treatment, and is often provided in the home . When a person with terminal illness feels that they have exhausted the benefits of ongoing aggressive treatment, they may decide that it is time to forego further “treatment” and focus instead on remaining as comfortable as possible for as much time as they have left.. The patient or their health care proxy decision-maker opts out of further curative treatment. The patient then will receive palliative care and pain control. The patient may be at home, in a health care facility or in a hospice facility. Medicare does not pay the room and board charges for hospice care. Although the point of decision may be more apparent for certain patients whose cancer treatment is no longer productive, there can also come a time when further treatment will be declined by a patient with stage four heart failure, or who has advanced alzheimers dementia  and other progressively degenerative clinical conditions such as congestive heart failure or kidney failure.

It is very important that all patients sign a health care proxy (to designate their medical decision-maker should they become incapable of making decisions), and if they have particular wishes regarding the use or non-use of lifesaving treatment,  an advance directive. When in the hospital, they or the health care proxy needs to make their wishes known so that the treatment doesn’t run away with the patient at a time that the patient or their proxy prefers to forego treatment.. In New Jersey, physicians must discuss these issues with the patient and complete a form called POLST setting down the patient’s wishes.

Elder Care requires a team approach. The palliative care team can greatly enhance the family’s experience at the end of life.

 For legal advice on preparation and implementation of health care directives, powers of attorney and elder care planning, call … 732-382-6070