What the Heck is POLST?

 

We have discussed what is wrong with the way that we handle end of life issues. We know that most elderly people do not have living wills. We know that the 20 percent of the elderly that do have living wills do not have them honored for various reasons. Studies show that the elderly want to die where they live, not in the hospital. We know that every study done regarding the use of living wills all show that they do not make any difference in honoring what an elderly person wants at the end of life. So, what does work?

A Few States Have Adopted POLST 

            Knowing that what we have been doing for the last thirty years regarding trying to respect the elderly and their end of life decisions has not been working, a few states have adopted a plan that does work. 

            This plan is known as POLST (Physician Orders for Life Sustaining Treatment).  POLST is a simple one page, brightly colored form that is meant for people who have a life expectancy of one to two years. This form clearly states what treatments an elderly person does or does not want. While one might say this was the purpose of the living will, it fell short in many ways. 

Why does POLST Work?

            The one big difference is with POLST, the plan is signed by a physician, nurse practitioner, or physician assistant. This gives validity and legality to the form in a way that was not able to be done with the use of living wills.  In an age of litigation, the POLST form is signed by the physician, the patient and/or family member. 

            Since the first use of POLST, over twenty years ago, there has been no litigation regarding the use of POLST. Most likely it is because it is signed by a physician as well as the patient and/or family. Additionally, the form is to be kept with the patient at all times. Remember last week when we spoke about the use of living wills and how most patients and families do not remember where they are or what they say. Since the POLST form must be kept with the patient at all times, patients and families are very well aware of what it says. Those living at home are encouraged to have it laminated and placed on their refrigerator. Emergency medical technicians know to look for a POLST order there in the kitchen when coming to someone’s home. 

            We’ll be talking more about POLST soon.