Today’s Senior Magazine, South Jersey Edition recently published an article written by Dana E. Bookbinder about the New Jersey POLST legislation in their August 2013 edition. Below is the text of that article, which can also be found online at Today’s Senior Magazine’s web site.
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Today’s Senior Magazine, August 2013 – New Jersey residents have a new tool through which they can ensure that their health care wishes are carried out by all medical providers. Signed into law on December 21, 2011 by Governor Chris Christie, the New Jersey POLST (Practitioner Orders for Life Sustaining Treatment) legislation became effective February 22, 2013. The legislation enables patients to use a standard new form to express their health care wishes and help patients and families with end-of-life care planning. Unlike a legal document such as an Advance Health Care Directive/Living Will or Health Care Proxy, the POLST is a doctor’s order.
The new form is to be printed in green or on green colored paper and is to stay with the patient at all times at home or in a healthcare facility. By law, the directives contained on the form must be followed by healthcare professionals. Jane Knapp, of Right at Home, an in-home agency, attended four training sessions on the POLST and is among the very few individuals in New Jersey trained on the POLST since the law was enacted. According to Knapp, only a primary care physician or an Advanced Practice Nurse (APN) is legally allowed to complete a POLST on behalf of an individual.
Aside from being a doctor’s order, the other significant difference between the POLST and a legal Advance Directive is the specific time frame and limited si
tuations which the POLST is designed to cover. The Advance Directive may be thought of as a broad framework out of which a care plan can be developed while a POLST is specifically designed for individuals with limited life expectancies and can be more specific in addressing the patient’s current condition. Knapp points out, “The key to POLST is it’s within the context of your own personal diagnosis … it’s very specific … It’s the now; it’s not the future.”
It is recommended that the POLST be reviewed frequently, and if there is a change in medical condition or residential setting, it may be changed accordingly. Whereas advance directives are designed to apply throughout an individual’s life unless his preferences change, Knapp stated, “The POLST is about immediacy… Every adult should have an Advance Directive but not every adult should have a POLST.”
Goals of Care
The POLST form contains two essential parts, the “Goals of Care” and the “Medical Interventions.” The “Goals of Care” section describes how one would like to live his or her life in the time he has left. The “Medical Interventions” section includes the patient’s preferences on life sustaining treatments including cardiopulmonary resuscitation, intubation, mechanical ventilation, artificially administered nutrition and/or hydration, and other specific medical interventions.
Patients should review their POLST forms regularly since they are so specific. For example, if a patient has cancer and then goes into remission, his preferences regarding life sustaining treatment may have changed. He should therefore sign a new POLST. If a cancer patient grows weary of medical testing or treatment and changes care preferences, a new POLST should be signed. In fact, according to Knapp, with each change of residence or transition of care – for example, a new hospitalization or entry into rehabilitation – the POLST should at least be reviewed. The urgency to continually update the form may well prompt more doctor visits.
Since the POLST is designed for patients who face end-of-life care decisions, the form should be kept in an obvious place in a patient’s home such as on the refrigerator or by the telephone. Patients are supposed to keep the original POLST with them while their doctor’s office maintains a copy. Of course, with each new POLST, the old original plus the copies should be destroyed to avoid confusion.
POLST v. Legal Healthcare Directives
While the goals of the POLST certainly overlap with advance directives, such as living wills and health care proxies, a POLST is not designed to replace a traditional Advance Directive. For example, a health care proxy or power of attorney appoints an individual who will serve as a patient’s health care agent. This person has the authority to communicate with a patient’s medical team based on instructions that the patient has provided in his or her Advance Directive. The health care agent can speak for the patient if the patient is unable to speak for himself. The health care agent can act whether the patient has a terminal end stage illness or whether the condition is not life threatening. Since it is possible for any individual to contract a sudden serious illness or injury, it is highly recommended that everyone age 18 and older has a healthcare directive.
Unlike a healthcare directive, the POLST does not name a healthcare agent and only focuses specifically on end-of-life decision making. In fact, it is designed to be completed only by individuals with life-limiting illnesses. If an individual lacks capacity to communicate his wishes enough for a POLST to be completed, a health care proxy, under an Advance Directive, can complete the POLST for him.
In addition to appointing a healthcare proxy, advance directives exceed the scope of medical issues covered by the POLST by including powers such as the authority to hire medical care providers on the patient’s behalf, do whatever is necessary to keep the patient in his or her own home even if he needs long-term care, hire psychiatric support if necessary, change healthcare personnel and visitation rights.
New Jersey is not alone in implementing the use of the POLST. The vast majority of states already have POLST programs or they are in the process of developing them. According to an article printed in the Cleveland Clinic Journal of Medicine in July 2012, the POLST has already been shown to improve a patient’s control over his or her health care. The form is designed to provide clear instructions about patient preferences that are easy to follow.
Once more physicians receive training to help patients effectively use the POLST, it will be a powerful tool to give patients control. It also vastly improves the communication between the patient and healthcare providers since it is a form easily recognizable by any medical professional treating the patient. Nevertheless, all adults should have an Advance Directive to address expected and unexpected situations when a patient cannot communicate for himself. The best decisions are generally made in advance in non-emergency situations and, now more than ever, those who plan ahead can customize and truly control their medical treatment.
DANA E. BOOKBINDER, Esq. advises seniors and families on asset protection for long term care expenses, disability planning, estate planning, and estate administration. She practices elder law with Begley Law Group, P.C., in Moorestown, Princeton, and Stone Harbor, New Jersey. Ms. Bookbinder has been certified as an Elder Law Attorney by the ABA accredited National Elder Law Foundation. She is a past Chair of the Elder and Disability Law Section of the New Jersey State Bar Association and past chair of the Burlington County Probate Committee. She often lectures to civic and retirement groups, is a frequent speaker for New Jersey State Bar Association Institute of Continuing Legal Education, and has appeared on radio and television to discuss planning for seniors.
JANE KNAPP, Marketing Director for Right At Home, an in-home care assistance and skilled nursing provider, has been involved at the State level, as the POLST form has evolved, and works to promote understanding of its appropriate use. She serves as Chairman of the Tri-County Regional Ethics Committee (TREC) and is part of the NJ State Ethics Consortium for Long-Term Care.
For additional information: visit the POLST national Web site – http://www.ohsu.edu/polst
Contact Dana Bookbinder at 856-787-4227/dbookbinder@begleylawgroup.com
Contact Jane Knapp at 856-795-9707 / jane@rahsj.com
