While visiting family at the hospital recently, I noticed a PowerPoint slide deck scrolling on a hospital screen discussing when completing a POLST form would be appropriate. Being the process nerd that I am, I thought that it might be appropriate to highlight a few things related to POLST as it fits into the overall portfolio of advance health care planning.
Advance Health Care Planning
If you are at least 18 years of age, you should have an Advance Health Care Directive. While it’s probably not as high on an average 18-year old’s priority list as playing Fortnite, it is critical for you to have in case you are seriously sick, injured, or worse. A key component of your Directive is designating someone (you should also include alternates) to act on your behalf should you be unable to do so. A few examples of what this person will have the ability to do is select or discharge health care providers, consent to treatment on your behalf, and make anatomical gifts if appropriate. And while it might be a family member that you choose to act in this capacity, it doesn’t have to be. I have a friend who didn’t select their sibling to make decisions on their behalf because said sibling isn’t exactly good at making critical decisions under duress. And that is perfectly acceptable. The important thing is that you talk to your designee to ensure that they are both comfortable with performing the duties within their role and that they are the appropriate person to do so. The remainder of the Directive allows you communicate your desires on organ donation, treatment options allowable to keep you alive (commonly referred to as “End-Of-Life” decisions), designate preference for burial or cremation, and optionally indicate who your primary physician is. Lastly, as with any critical document, it’s important to periodically review the contents of your Advance Health Care Directive to ensure that it still reflects your desires and values. While the Advance Health Care Directive allows your designees to act on your behalf, it may not give them the ability to share your medical information with the appropriate people as might be needed for proper treatment. So, what does?
Endorsed by Congress in 1996, The Health Insurance Portability and Accountability Act (HIPAA) is intended to protect your confidential medical information from being released, used, or disclosed by others without prior authorization to do so. In addition to the typical “covered entity” such as your health care provider, you can appoint specific authorized recipients to receive your health care information. This document is referred to as a HIPAA Authorization. The authorized recipients are typically the same individuals that are identified within your Advance Health Care Directive. You can however authorize additional individuals as necessary. As an example, my friend wants their sister to receive medical information via the HIPAA but as mentioned above does not want the sister making potentially life altering decisions that would be given to her in the Advance Health Care Directive. The significant point being made here is that your Advance Directive, HIPAA Authorization, and Health Care Power of Attorney (we’ll talk about that next) documents are all independent of each other but designed to work together.
Rounding out the Triple Crown of Advance Health Care Planning is your Health Care Power of Attorney. This document allows you to name individuals to act on your behalf as your Health Care Agent. These individuals should be the same as identified in your Advance Health Care Directive lest conflicts on medical treatment decisions arise by having different people named in each form. So how is it different than the Advance Directive? Where the Advance Directive is geared more for making acute care and end of life decisions, the Health Care Power of Attorney is designed to make decisions for long term care such as at nursing home or hospice care within your personal residence. All three of the aforementioned documents should be executed simultaneously and reviewed periodically.
This was supposed to be a quick blog on POLST and I spent a whole page not even talking about it. Let’s change that!
Physicians Orders for Life Sustaining Treatment (POLST)
A POLST form is a medical order signed by your physician. Medical personnel performing treatment on you are legally obligated to follow its directions. This is a document that you would complete when you are medically frail but still able to make decisions on your own and are ready to put medical treatment plans into action as a result of a prognosis where the terminal outcome is expected to be within a short period of time. Copies of this form may be kept by your physician, your chosen hospital, with you, or all the above. The bottom line with a POLST is that it can and should work in conjunction with your Advance Health Care Directive but is a legally enforceable document to guarantee that actions your desire (remember that they must be signed off on by your physician) are taken. A POLST is not required (often the Advance Health Care Directive is all that is needed to care for your wellbeing) but is just another tool to have in your health care planning toolbox. Specifically, in situations where there may be discretion on treatment options that your Directive may not cover.
While for the young of age or young of heart these documents are not exactly as exciting to contemplate as what game you’re going to play next on your PlayStation, they are important. So, put down your game controller and pick up your phone and give us a call or e-mail should you have further questions on this topic or need assistance.