What you didn't know you didn't know about senior living: POLST
- Tracy Berg
- Jun 22, 2017
- 3 min read
A POLST form. Many are bright pink or lime green to help them stand out in an emergency situation.
If you have any sort of medical training and you were to come across someone who is not breathing, you have a strict order of operations that you follow. You call 911, check the scene to see if it’s safe, and do your best to administer appropriate care until the paramedics arrive, which would probably include CPR (cardiopulmonary resuscitation). In ALF, there’s an added step that we have to take before we can begin CPR, and that is to confirm whether the resident is full code or DNR.
This preference is indicated on a form called a POLST, or Physician Orders for Life-Sustaining Treatment, which is a medical form signed by a Physician. All medical personnel (including ALF staff and EMTs) are required by law to follow the instructions of the POLST. There are several different options for preferences, but the first thing anyone preparing to administer medical treatment will look for is whether the patient is full code or has a DNR.
Full code indicates that someone would like all forms of treatment if they’re found unresponsive. They’re giving medical professionals permission to try and resuscitate them by any means possible, including oxygen, suction, IV fluids, intubation, mechanical ventilation, and more. DNR, on the other hand, stands for Do Not Resuscitate, and indicates that very limited measures only are to be taken, and that the patient would prefer to AND, or Allow Natural Death.
It can seem surprising to non-medical people that someone would essentially choose not to prolong their life, but when you consider an elderly person, you have to consider their quality of life. If EMTs were to administer effective CPR, there is a chance that they could break the patient’s ribs, and cause additional health issues that might inflict greater pain and end their life regardless. I have residents who have indicated DNR on their POLST because they have lived a long, full life, and while they aren’t anxious to die, they have prepared themselves for the inevitability that it will happen, and it could be soon.
It can also come as a shock that we would delay CPR, a potentially life-saving treatment where every single second counts, long enough to verify a resident’s wishes on their POLST, but we are legally obligated not to administer CPR if a resident has a DNR. Let’s say we were to start CPR on a DNR resident and they did end up regaining a pulse, but perhaps never regain consciousness (which is a very likely outcome). They are most likely in pain and agitation, and the family then becomes responsible for making the resident’s end-of-life decisions without knowing what their preference is. A patient might rack up thousands of dollars in medical bills only to have the family decide to ‘pull the plug' days later.
A Living Will (or Advanced Directive) is a more common end-of-life form than a POLST, but there are a few key differences. A POLST must be signed by a Physician, and it is a legally binding document, whereas medical professionals are not bound by the law to follow the instructions on an LW. An LW can be filled out at any time during your life, but a POLST is usually only recommended when you’ve reached an advanced stage of illness.
It’s not easy to broach the subject of death, but it’s important to consider. If you were to suddenly be rendered unable to make decisions for yourself tomorrow, would your family know what to do? Would you feel confident that a loved one you trust would be able to guide care staff in the manner of your wishes? It’s difficult to consider how extensive of end-of-life care you’d like to receive when you’re healthy, but if you have a family or are approaching the retirement-and-beyond stage of life, I urge you to consider filling out at least an LW so that if a crisis were to occur, your loved ones would not have to struggle to make assumptions on your behalf. If your family had a document that guided them in the manner of your wishes, they could make a decision with peace knowing that you had made the decision before, and they were merely responsible for ensuring it was carried out.
