Hospice Defi nitions

Do you or your loved one have a serious medical condition, such as advanced heart, lung, or kidney disease, cancer, liver failure, Parkinson’s, or dementia?

Individuals with a serious illness may want to make very clear their wishes regarding the type of care they want to receive, or do not want to receive, if their condition progresses. The Pennsylvania Orders for Life-Sustaining Treatment (POLST) form is a document that helps to ensure that patients’ wishes regarding medical treatments during emergency situations are made known to doctors, nurses, and other healthcare providers.

POLST is not intended to replace an advance directive (such as a living will or healthcare power of attorney). The POLST form documents the patient’s preferences for resuscitation, intensity of care, use of tube feedings, and other medical interventions. It is completed after a conversation between the patient and doctor or other healthcare provider. If a patient is unable to have the conversation, the doctor may speak to the patient’s legal medical decision-maker.

POLST is valid and eff ective once it is signed by a doctor or nurse practi-

Pennsylvania Orders for Life-Sustaining Treatment (POLST)

(also known as Portable Medical Orders)

Hospice Care Defi nitions continued from 135

INDIGENT PATIENTS – Does the hospice accept non funded or indigent patients? This is usually on a case by case basis and at the determination of the hospice company. Many have a non-profi t organization that can help support the care of non-covered patients.

PAIN PUMPS AVAILABLE – Many patients have their symptoms controlled through oral medications. Some situations require a pain pump where medications are administered through an IV pump. If this is the situation, inquire with the hospice RN case manager to see if pain pumps are available through their agency.

PALLIATIVE CARE – Specialized medical care for people with serious illness. It is focused on providing patients with relief from the symptoms, pain and stress of a serious illness – whatever the prognosis. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment.

tioner and the patient or his medical decision-maker. It then becomes a specific medical order designed to be honored by healthcare workers during a medical crisis. This is a distinctive difference from an advance directive, which identifies an individual’s preferences for future medical care or conditions. The chart below explains the difference between an Advanced Directive and POLST.

The POLST form travels with the patient between care settings such as home, hospital, long-term care, or any other facility. The POLST form is printed on bright pink paper so it can be easily seen and medical choices recognized wherever someone is receiving care.

If you think a POLST is right for you or your loved one, talk to your healthcare provider. Your doctor, nurse, social worker, or other healthcare professional is the best resource for information about POLST.

The following websites also provide more detailed information on POLST: • www.polst.org (Watch the How

Hope Grows short video) • www.papolst.org (Go to “For

Patients and Families” from the home page, then select “POLST” for links to a brochure and other helpful information.)

Editor’s Note: This article was submitted by Lisa George, MPH, CHES with special thanks to Marian Kemp, RN, of the Coalition for Quality at the End of Life (CQEL). DIFFERENCE BETWEEN ADVANCE DIRECTIVES AND POLST

Advance Directive POLST For all Adults For patients with serious illness or frailty Who completes forms Individuals/patients Healthcare Professional Where completed Any setting, not necessarily medical Medical setting: doctor’s office, hospital, long-term care, other Resulting product Appointment of a legal medical decision maker and statement of treatment preferences Valid medical orders based on conversation and shared decisionmaking Becomes effective Patient is incompetent, and; permanently unconscious or has endstage medical condition When signed and dated by doctor, CRNP or PA and by patient or medical decision-maker

Patient’s legal medical decisionmaker role Cannot complete Can consent if patient lacks capacity and unable to consent to medical care

Portability Patient/family responsibility to share with health care providers at treatment sites Health care professional responsibility to assure form travels with patient across care settings

Periodic Review Patient/family responsibility Health care professional responsibility to initiate