Editor’s Note: This is part of a series of columns that will be presented in this newsletter by Sam W. Boone, Jr., a local attorney whose primary practice areas include elder law, estate planning, probate and trust administration. It is hoped that the information will be valuable for caregivers and family members dealing with issues related to elder law.
A few years ago a woman I never met was living in a local nursing home. This woman had not spoken in more than a year, could only sit or lay down and was totally dependent on others for her feeding and care.
One night she choked – medical staff believe it may have been on some food. She stopped breathing. The family had a DNR order, and there was an Advance Directive detailing end-of-life care. Nursing home staff, in what was described later as an honest mistake, called 911. The woman was revived, taken to the hospital, put on life-support and lived for another week before passing away.
Had POLST (Physician Orders for Life-Sustaining Treatment) existed in Florida at the time, this unfortunate set of circumstances, in opposition to her wishes and her family’s, may have been avoided.
POLST is designed to complement Advance Directives – not replace them. POLST lists the types of treatment that are wanted or not wanted. It is a program that includes education, training and a quality improvement process.
POLST got its start in Oregon in 1991. Florida’s POLST program is a project in development at the Center for Innovative Collaboration in Medicine and Law – a joint effort of the FSU College of Medicine and FSU College of Law.
POLST is voluntary and can be revoked or replaced with a new one at any time. In fact, having more than one POLST as a disease progresses is common. It differs from an Advance Directive in that it is generally used with people having a serious illness. Advance Directives are usually completed with an elder-law attorney but POLSTs are usually done in a medical setting. Advance Directives state preferences and a surrogate, while POLST results in medical orders based on shared decision-making with the patient and medical-care professionals.
So the medical-setting conversation results in actionable medical orders that are recorded in a standardized POLST form kept in the front of the patient’s medical records or in their home. The POLST always addresses cardiopulmonary resuscitation, and also can address other end-of-life healthcare issues, such as the level of medical intervention desired in an emergency, the use of artificially supplied nutrition and hydration, the use of antibiotics and the use of ventilation. They are designed to be recognized across the healthcare community.
Back to the woman I talked about at the top. Today I work with her family. There’s no way of knowing for sure if the medical staff at the nursing home would have acted differently had there been a POLST form at the front of her chart or posted at her bed. One would hope that it may have. But the important thing is that a tragic incident like that becomes a learning opportunity. People who are trained in the medical arts want to save lives. But the more we discuss the wishes of the patients and the family, the more likely those wishes are taken into account. POLST is one more step in helping with that process.
To learn more about POLST, go online to www.polst.org.
Sam W. Boone, Jr. is a Gainesville-based attorney practicing elder law and estate planning. He is past-president of the Academy of Florida Elder Law Attorneys. To learn more about elder-law issues, go online to www. http://boonelaw.com, or call (352)-374-8308.