In a recent post, we provided simple definitions of advance directives terminology. These terms can be confusing – even to caregivers – so I want to use this blog post to better explain when you should consider each.
Advance care planning is a life-long process. Unforeseen events can happen at any time, including accidents or illnesses that can lead to inability to make decisions. The most important first step in advance care planning is to complete a Power of Attorney for Health Care form (POA-HC).
Stage 1: Power of Attorney for Health Care
This is the most common and far-reaching advance directive. It allows the patient to appoint an agent to make health care decisions for them when they are unable to do so, in any circumstance.
It is extremely important to have a conversation about treatments you would or would not want in various scenarios. As time goes by, your health may change, so you need to keep the conversations going with your agent and family. After all, you may want to change the decisions you made earlier.
Everyone over the age of 18 should have a POA-HC. This is especially important if you are over 50.
Stage 2: Physician Orders for Life-Sustaining Treatment (POLST)
This is a new type of advance directive. In addition to the POA-HC, having a POLST becomes important toward the end of a person’s life. This form is intended for use in the late stages of a life-limiting illness, for the frail elderly, and for the person who the physician expects could die in one year.
POLST forms are medical orders, allowing a patient’s decisions to be acted on immediately, wherever they are. POLST forms are not generally meant for healthy persons. While completing a POLST, your caregiver will discuss things you may encounter in your specific disease.
Common Questions About POLST
What does the POLST form do?
POLST allows the patient to give their directives about various forms of life sustaining treatment including CPR, comfort measures such as medications and oxygen to manage distressing symptoms, limited additional interventions like antibiotics, IV fluids, and cardiac monitoring, full treatment such as intubation, and mechanical ventilation.
If a POLST form is completed, do I need a Power of Attorney for Health Care too?
Yes, a POLST from does not take the place of the POA-HC form. See the comparison of the two forms below.
|Intended for adult patients of all ages||Intended for seriously ill patients expected to die within one year|
|Appoints an agent to make all medical decisions for patient when they lose capacity||Patient or patient’s legal decision-maker makes life-sustaining treatment decisions that are translated into physician orders.|
|Becomes effective when patient loses decisional capacity||Is immediately effective|
|Information in POA-HC are not physician orders||POLST includes specific physician orders|
|Completed with patient and advance care planning facilitator or lawyer||Completed with patient or patient’s legal decision-maker and physician|
|Can be changed or voided at any time||Can be changed or voided at any time|
|Does not require notarization||Does not require notarization|
|Medical decisions for patient can’t be made in absence or agent or successor agent||Medical decisions for patient can be made in absence of agent or successor agent.|
How do the patient’s directives become physician orders?
By signing the POLST form, the physician turns the patient’s directives into medical orders. These orders should also be entered into the patient’s medical record.
Do these physician orders in POLST remain effective all settings of care?
Yes, once the form is completed it is transferable across all care settings with instructions to re-evaluate it each time. For example the orders would be honored while in the ambulance, at home, or in a nursing home.
Where do I go to get a Power of Attorney or POLST form?
If you or your family member would like to complete a POA-HC and/or a POLST form, please contact your primary physician.