Advance Care Planning / POLST
Set Up an Advance Directive in LA & Orange County, CA
Agape Hospice & Palliative Care helps patients in hospice care plan for end-of-life with an advance directive and POLST. We strive to help patients keep control of their healthcare. Advance care planning ensures that our patient’s voice is heard even when they are no longer able to communicate. Advance directives are legal documents that voice the patient’s written wishes, preferences, and choices regarding end-of-life decisions. These documents act as a roadmap for communicating future healthcare decisions and preferences. Patients who have an advance directive take control of their healthcare decisions in situations where they no longer have a voice.
What Is an Advance Directive & Why Is It Important?
Agape’s philosophy of hospice is to always keep the patient in control of their healthcare, which is why Advance Care Planning is so important. Advance Directives are legal documents that allow the patient to voice their written wishes, preferences, and choices regarding end-of-life healthcare decisions. Think of them as a roadmap to help you think through and communicate your wishes regarding your future healthcare decisions if you are seriously ill or injured and unable to speak or express your decisions. When a patient has no Advance Directives they will receive the “standard of care,” which is what is automatically provided to anyone in a similar situation. During a medical emergency, it means doing everything medically appropriate and possible to attempt to save your life. This can mean providing cardiopulmonary resuscitation (CPR) to attempt to bring you back to life, transporting you to the hospital, and possibly putting you in the intensive care unit (ICU) on a breathing machine. If you can’t communicate and the health care team needs to make decisions for you about medical treatments, they will look at the relevant state law (or, in states where there is no applicable law, or facility policy) to determine who can help make those decisions for you. In a worst-case scenario when a patient’s family or care team disagrees on what appropriate care to provide, the decision can ultimately made through proceedings. Most patients who have an advance directive are older adults, but it’s never too soon to take preventive measures in the event of an emergency. While you do not need a lawyer to fill out an advance directive, your advance directive becomes legally valid as soon as you sign it in front of the required witnesses. Advance directives do not expire. An advance directive remains in effect until you change it. If you complete a new advance directive, it invalidates the previous one.
Power of Attorney for Health Care
In California, power of attorney for health care allows the patient to designate an individual as their agent to make health care decisions for them in a situation when the patient cannot represent themselves. The patient must be in a clear mental state before selecting their agent (Also referred to as Health Care Proxy, Health Care Surrogate, or Durable Power of Attorney for Health Care). The patient can revoke their agent’s authority at any time, or if the agent is not willing, able, or reasonably available to make a health care decision for them. The patient can also select an alternate agent. The agent has the authorization to make all health care decisions including decisions to provide, withhold, or withdraw artificial nutrition and hydration and all other forms of health care to keep the patient alive. The document also allows the patient to make certain exceptions or limit the agent’s authority. This designation obligates the agent to the best of their ability to carry out the patient’s health care wishes. The agent can be anyone the patient chooses and is only authorized to speak for them if they are unable to make their own medical decisions.
Instructions for Health Care / Living Will
This part is a legal document with your wishes about medical treatment. You choose what you do want and don’t want. In hospice, this is YOUR journey, and you choose the path you wish to take.
End-of-Life-Decisions
The patient here directs health care providers and others involved with their care to withhold or withdraw treatment in accordance with their wishes listed below.
(a) Choice Not to Prolong Life
I do not want my life to be prolonged if I have an incurable and irreversible condition that will result in my death within a relatively short time, I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or the likely risks and burdens of treatment would outweigh the expected benefits, OR
(b) Choice to Prolong Life
I want my life to be prolonged as long as possible within the limits of generally accepted healthcare standards.
Relief From Pain
The patient also has the option to direct that treatment for the alleviation of pain or discomfort be provided at all times, even if it hastens their death.
Donation Of Organs, Tissues, And Parts At Death
Organ donation is generally referred to in the Act as an “anatomical gift,” and allows the patient to express their desire to be an organ or tissue donor at the time of their death. The patient can also authorize the agent to consent to any temporary medical procedure necessary solely to evaluate and/or maintain the patient’s organs, tissues, and/or parts for purposes of donation. The patient can even specify if their gift will be used for Transplants, Therapy, Research, or Education.
It is important to note that this is not covered or left blank in the Advance Directive, it is not considered as a refusal.
POLST & DNR Orders
Advance Directives and POLST (Physician Orders for Life-Sustaining Treatment) forms are both advanced care planning tools, but they are different in many ways. Advance Directives are a legal document, while a POLST is a physician order that helps give seriously ill patients more control and a voice over their end-of-life care. POLST forms are on a distinctive bright pink form and signed by both the doctor and patient and specify the types of medical treatment that a patient wishes to receive or not receive. The POLST can prevent unwanted or medically ineffective treatment, reduce patient and family suffering, and help ensure that patient’s wishes are honored. The POLST form includes whether to:
- Do not attempt Resuscitation (DNR)
- Administer antibiotics and IV fluids
- Use a ventilator to help with breathing
- Provide artificial nutrition by tube
- Attempt cardiopulmonary resuscitation (CPR)
The POLST form complements an Advance Directive and is not intended to replace that document. An Advance Directive is still necessary to appoint a legal health care decisionmaker and is recommended for all adults, regardless of their health status.
While POLST and Advance Directives are not required by law, most Doctors recommend that seriously ill patients and those who have a significant chance of dying should have them. As we all have recently seen something like COVID-19 can change everyone’s future rather quickly.
The Advance Directives and POLST can be changed at any time and our Social Services Team and Clinical Team are always here to help.