POLST Form - Physician Orders for Life-Sustaining Treatment Form - overwhelming

CaliforniaGirl-1 · March 2024

My LO is very, very elderly. She was recently hospitalized and had surgery. We had to make a lot of decisions fast and under pressure in the ER. But luckily it all went as well as could be hoped. She is definitely more fragile than she was before the whole thing but she is doing well.

Her physician's practice is all elderly people in AL and MC, who comes to see them, in place, where they live, in their care communities. When he saw her recently, we had a discussion about the POLST form on file and that goes to hospital and the decisions we had to make under pressure, so to speak.

Like probably most people, my sibling and I are overwhelmed with making these choices for our LO, and didn't really understand the implications of each and when we might want to change them. Her doctor had a call with us (my sibling lives out of state but has been an active participant in my LO's healthcare decision making). The doctor went over the form with us and explained the choices and various , possible and likely outcomes and what they meant for a very elderly person in my LO's condition and what are the options in each case.

It was a good discussion and we each got to ask our questions. It was good to have it, when we were not in the middle of a healthcare crisis. We have changed a lot of choices on the form and understand more what those choices mean and when we may want to change them again. I am feeling a lot more comfortable than before and I think my sibling and I are more on the same page now. When only one of us is speaking to the doctor in real-time it is easy to get disconnected.

If you are feeling overwhelmed with this kind of thing. I really recommend it, if your LO's doctor will spend some time with you. For us, it was definitely worth making a doctor's appointment to do it.

So much of caring for a parent with dementia is just doing our best and hoping against hope that we are making the best decisions for them.

M1 · March 2024

you might want to read the book "Being Mortal" by Atul Gawande. We all die, and our loved ones have an excruciating, terminal disease. Death would be a welcome thing in our household.

LYDIALINDBERG · January 10

Might you be able to share the name of the doctor? Tks Much.

ARIL · January 11

My PWD was sent to the ER the other day. The nurse from his MC called me at work to tell me he was in the ambulance. I had my spouse take a copy of the completed POLST to the hospital, and when I arrived I was relieved to see that the MC had sent it with my PWD in the ambulance already.

The presence of the POLST form made the whole experience so much easier, because it was already clear exactly would happen in the case of cardiac arrest or other event of that nature.

Readers of the forum may want to see more details about the differences between an advance directive and a POLST form. Here’s one source: https://www.merckmanuals.com/home/multimedia/table/differences-between-advance-directives-and-polst

I echo the recommendation of Gawande’s book Being Mortal. I read it recently on the advice of a commenter on this forum and found it both reassuring and life-affirming.

ARIL · January 11

One more thing: there is state-by-state variation in terminology, and not all states use a POLST-type form.

Some states use POLST (physician [or provider] orders for life-sustaining treatment). Others use different acronyms for the same or similar forms: POST (physician orders for scope of treatment), MOLST (medical orders for life-sustaining treatment), MOST (medical orders for scope of treatment), or COLST (clinician orders for life-sustaining treatment).

See https://polst.org/state-polst-programs/

CaliforniaGirl-1 · January 11

https://alzconnected.org/discussion/comment/263209#Comment_263209

I want to be helpful but I don't think I can. It was a medical service for a patient, reviewing the form and explaining it with detailed personal and professional knowledge of the patient's age, condition and needs. I think the form is state specific. I will say it counted as a visit.

I really recommend reaching out to your LO's physician and if you are their medical power of attorney or representative for health care or whatever is the terminology in your state, ask them to review it with you based on your LO's current condition.

One thing to keep in mind, is that this is probably not a "once and done situation." We recently re-reviewed and updated the form based on changes in my LO's condition. So I would plan on reviewing it periodically.

I can only say that when my very fragile, elderly LO was hospitalized, before they were on hospice the doctors in the hospital were very relieved that there was a form giving them some guidance.

Sorry not to be more helpful.

POLST Form - Physician Orders for Life-Sustaining Treatment Form - overwhelming

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