Topics in Elderly Home Care: Understanding POLSTs

If you don't even know what a POLST is, don't despair.

elderly home care

I didn't either until it was mentioned in May at the Southeastern PA Alzheimer's conference in King of Prussia.  So as an elderly home care provider, it was time for me to do my homework.

POLST stands for "physician orders for life sustaining treatment."  This is a concept which adds to the evolution of the "Advanced Directive" or "Living Will" documents that are popular today in elder care end of life planning.

An Advanced Directive is a legal document in which you write down what types of future care you want and who you want to make medical decisions for you if you become incapacitated or as you near end of life.  Most advanced directives consider things like whether you want antibiotics, tube-feeding, mechanical ventilation (breathing), and so forth.  When you write an advanced directive, you are speculating on the various possibilities of care that you might need as you near end of life and how you want them to be handled.

Contrast that with a POLST which is a doctor's order that identifies and enforces what life-saving treatments you will have based on your current medical condition. Essentially, a POLST puts your advanced directive into practice in health care settings.  In the absence of doctor's orders, everyone in the medical profession takes an approach of providing every means of treatment possible to save a patient's life.  But, that may or may not be what the individual really wants.

To understand how this might happen in reality, consider this scenario:  You are receiving comfort care only (no "heroics") in an elderly home care facility according to your wishes as documented in your advanced directive.  However, late one night a doctor who isn't familiar with your case checks on you and finds you have a fever and rapid breathing.  She can't reach your power of attorney and transfers you to the local hospital for treatment for pneumonia.   Once the treatment begins you improve somewhat and a speech therapist is called because your swallowing is labored.  He recommends a feeding tube.  Finally, your power of attorney arrives at the hospital and is upset at all these "heroics" that he knows you didn't want.

So, how did this happen?  Well, advanced directives are written "in theory" (before you are ill) and they require decisions to be made by medical professionals.  In general, these medical professionals take measures to save lives.  By having a POLST in your current medical records, the chances are much higher that your wishes that were once theoretical are now granted.

One important thing to note... not all states have the same level of maturity in their laws about how these various documents are used and enforced.  The University of Pittsburg has taken a lead on this topic in the state of Pennsylvania, and has an excellent web site.

Upon first read, this all may seem very complicated and subtle to you.  It sure did to me!  Here are a few more links with a lot of information to help you better understand this new concept:

Article from Florida State University College of Medicine comparing POLTS and Advanced Directives

Video on POLSTs in Pennsylvania