Transcription:
Advanced Healthcare Directives and POLST

Melanie Cole (Host): Advanced care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own healthcare decisions, and planning for healthcare in the future is such an important part and step toward making sure you get the medical care you would want. My guest is May Ronci, she's the Palliative Care Program Navigator at Henry Mayo Newhall Hospital. May, what is advanced care planning, and why is this so important really at any age, and even for younger people to consider?

May Ronci, BSN, RN, CHPN (Guest): Hi. Good morning, Melanie. Yes, advanced healthcare planning is so important because it allows you as the patient to put your medical wishes and desires down into paper and on writing, so that we as healthcare professionals know what to do or what not to do for you if you come into point of crisis or some kind of a trauma where you cannot speak for yourself. So essentially it's your voice on paper so that we know how to treat you when you come in, in a difficult situation.

Melanie: So then what is an advance directive? People don't know what this is. They hear about end of life care, and they hear about a living will, and an advance directive. They don't know the difference between all these things, May. Kind of clear it up for us a little bit.

May: Sure, so a living trust is something that you would execute with an attorney, and that addresses more than just your medical healthcare decisions. That would address your real estate, your finances, your banking, et cetera. An advance healthcare directive is specific to your healthcare, and this is recommended for anybody over the age of eighteen, and what it does is it allows you to name two decision makers, and in some cases three decision makers if you're unable to speak for yourself. So in the instance where if I was to have a motor vehicle accident, and I'm deemed unconscious, I have listed my husband and my sister as my decision makers for my medical healthcare, and that's all they have authority to do on an advance healthcare directive, unlike a living trust which allows you to appoint somebody to be your attorney in fact, or somebody who can make decisions for you in regards to your banking needs, your real estate, your finances.

So in the advance healthcare directive, you can appoint those two people to make decisions for you in regard to CPR and life support, feeding tubes, even as far as in my advance healthcare directive, I've even laid out how I would like to be cremated, et cetera. Even songs you want played at your funeral, and some people will go to those extents in their advance healthcare directive.

Melanie: May, picking somebody to be that healthcare proxy, picking somebody to follow those wishes is not an easy decision. Also, getting started with that conversation. Some people, whether you're the one looking to make your advance directive, or you are maybe the child of an aging parent, and you want to start this discussion. That's a difficult part. Some people don't want to talk about this. How do you recommend to people to discuss this?

May: I absolutely agree. Actually, I have a lecture that I taught, it's called Let's Talk, because it is a very important discussion, but it's also a very difficult one. I think it's important that you do have the conversation with your family, and let them know that these are decisions that I have made for myself, so that they understand that it's not anything- not a burden that you're putting on them, but these are your decisions that you're putting down into writing. It's also important that you pick your healthcare proxy to be somebody that you trust to be able to carry out those wishes for you, and that it isn't going to change the course of your plan if they're pressured by other family or they get scared. So you want to make sure it's somebody that you trust will be able to carry out your wishes for you.

But at the same time, they can't be expected to carry out those wishes if the conversation isn't had with them. So I completely agree with you. I think it's very important to be able to complete those forms with your proxy so that they know exactly what your wishes are, so that you can tell them, "This is why I've chosen this, and these are the things that I would hope you'd be able to carry out for me."

Melanie: So it is such an important discussion, and when you are discussing it, what decisions- you mentioned CPR, and some other things a little bit earlier. What decisions is it that we're talking about that you want to discuss, whether it's the use of life support, ventilator, removing that sort of thing, advanced measures to keep you alive? What are those decisions that you are talking about?

May: Right, so some of the decisions that you can make- and there's varying forms throughout California and other states. So depending on the form that you've selected to complete either with an attorney or just going online and looking at the Five Wishes form, most of them are pretty standard in that they do ask, "Do you want your life prolonged?" That's the first question that's usually asked, and that would mean, "Yes I want my life prolonged," meaning you would want CPR and you would want life support or no. The next question would be in regard to organ donation, and how you feel about if you had an untimely death, and you were a candidate to donate organs, is that something you would be interested in doing? Feeding tubes and artificial nutrition and hydration. If you can't be fed by mouth, do you want a surgically implanted tube into your stomach to give you nutrition and hydration? And those are some of the things that that form addresses.

Some other forms will also ask how you would want your remains to be handled. Do you want an autopsy? Some of them get very detailed, so it's very important that you answer all those questions, and try not to leave any of those answers blank, because then you're really leaving it up to other people to make those decisions for you.

Melanie: Well that's a good point to make. So how does somebody get started? And also speak about the difference between an advance directive and a physician order for life-sustaining treatment, what POLST is.

May: Great, so and you can get an advance directive online and print it out. An advance directive does require you to either have it notarized or to be signed by two unnamed witnesses. So your proxy one and proxy two cannot be your witnesses signing on to legalize the advance directive. So that's the one thing with the advance directive, and again you can get that anywhere.

A POLST, as you mentioned, a physician's order for life-sustaining treatment is a bright pink form for the state of California. Those really should be obtained and completed with your physician because that is an informed consent, and it really needs somebody in the healthcare- whether it be a physician, a nurse practitioner, or a PA to complete with the patient. Because there's some much more detailed questions in the POLST. And the POLST is not really recommended for everybody. It's more for somebody who is frail, who has advanced age, or has a serious progressive illness that might be life-limiting. My question to always ask would be, "Would I be surprised if this patient died in the next year?" And if my answer is, "No, I wouldn't be surprised because they have so many significant and complicated medical illnesses," then that patient should have a POLST as opposed to an advance directive.

And that does not need to be signed by a witness or a notary, that's signed with the patient themselves and their physician, nurse practitioner, or PA. The only big difference between the two forms is the POLST does not mean decision makers. You are your own decision maker, you are your own spokesperson, and those are your wishes that nobody can take away from you.

Melanie: So now making this all official, and where do you keep it? So if you've done your advance directive, you've done a POLST, you've discussed with your family, with your physician, all of these bits of information, May, where do you keep it so that if you are somebody who has a terminal illness, and you've decided these things, but EMS is called, or you are unconscious and can't speak for yourself, where do you keep it so that everybody knows?

May: That is such a great question because that is something that we are faced with a lot of times when patients come to the emergency room because they have these amazing forms that they've taken the time to complete, but nobody knows where to find them, and nobody knows that they're even completed.

The POLST is really encouraged to be placed somewhere visible whether it be by the front door, over the patient's area where they're sleeping, so that if EMS is called they can see that, and because it's a physician's order, they will honor it. An advance directive- and you know again, copies of these forms are acceptable to bring to the hospital if an original isn't readily available. But it's important to also give copies to your family, and especially the people in the advance directive that you're naming your proxy one and proxy two. They should have copies for themselves so that they know what your wishes are, and anybody that you think might be involved in your care should know what your wishes are.

But the POLST- I always recommend putting it into a plastic sleeve and putting it somewhere near where you sleep, or by the front door. Especially if we have a patient on hospice, it's important that those things are visible to EMS, should they be called in by somebody who doesn't know what the patient's wishes are, or what the patient is going through.

Melanie: Really such important information. I don't care what age you are, but this is something that we really all need to know, and people don't always want to discuss it. Wrap it up for us, May. Your best advice, what you want people to know about living wills, advance healthcare directives, POLST, really just getting that discussion started, going online, looking up the information, what do you tell people every day?

May: I tell people how important it is to have those forms completed. And you're right, regardless the age, because unfortunately death does not discriminate. I lost my husband when he was forty-three years old to a motor vehicle accident, and sadly he did not have wishes put in writing. We had to make those difficult decisions.

Your advance healthcare directive, your POLST are really a gift to your family and to yourself, but mostly to your family so that they aren't burdened with having to make those very difficult decisions should an untimely death or an untimely accident come to you. So it's really important to have those things done, and make sure that your friends and family, people who are important to you know what your wishes are, and when you come to the hospital for anything, make sure you bring those forms with you so we as healthcare professionals are able to respect your wishes and are able to carry out those decisions that you've made for yourself and respect your autonomy.

Melanie: Great information. Thank you so much, May, for coming on and really explaining it all so clearly for us, and the importance of it. You're listening to It's Your Health Radio with Henry Mayo Newhall Hospital. For more information please visit www.HenryMayo.com. That's www.HenryMayo.com. This is Melanie Cole, thanks so much for tuning in.