If you or a loved one need to plan for advanced care, it’s important to understand the legal and medical documents you can use to guide providers in their care. Two of these: health care proxy and POLST, are very important ways to ensure your wishes are carried out.
You may be wondering if you should assign a healthcare proxy to make decisions for you when you can’t, what that might entail, and what powers they’d be granted. This article will explain, including how to assign a health care proxy, who should have one, and some tips to make sure you don’t miss important details.
What Is a POLST?
The term POLST refers to both a form and a process. POLST is an acronym that stands for Physician Orders for Life-Sustaining Treatment. A POLST form is a portable medical order that allows a physician to establish a set of medical orders that are transportable from one institution to another.
For example, a POLST form might allow you to transfer medical orders between a residential care home and a hospital.
The objective of POLST forms is to promote consistency and propriety of care, particularly for vulnerable older adults.
Different Names for a POLST in Different States
Depending on your state, POLSTs are known by several different names, including:
- TPOPP – Transportable Physician Orders for Patient Preferences
- MOLST – Medical Orders for Life-Sustaining Treatment
- MOST – Medical Orders For Scope of Treatment
- POLST – Provider Orders for Life-Sustaining Treatment
- COLST – Clinician Order for Life-Sustaining Treatment
What is a Health Care Proxy?
A healthcare proxy is someone appointed to make medical decisions on behalf of another person — usually a family member — in the event that the person can’t communicate or make these decisions for themselves. You can legally appoint a health care proxy with a form called advance directives.
Depending on the state you live in, other names for a healthcare proxy may include:
- Surrogate
- Proxy
- Decision maker
- Health care power of attorney
Are you or a loved one living with a chronic or terminal illness?
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Are you or a loved one living with achronic or terminal illness?
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POLST vs Advance Directive
An advance directive is a legal document in which someone can:
- Name their appointed healthcare proxy
- Give instructions for making decisions about their care, usually in end-of-life care situations
- Provide information regarding their values, religious or spiritual beliefs, and any general preferences regarding treatment and medical care
An advance directive comes from the patient. It’s not a medical order, which comes from a physician. Depending on the state you live in, people may refer to this as:
- An advance directive
- A living will
- A health care power of attorney document
A living will pertains to wishes regarding care and treatment. A healthcare power of attorney appoints the named healthcare proxy. Together, they create the advance directive. Learn more about Advanced Directives in this article.
A POLST form isn’t an advance directive, nor is it a substitute for an advance directive.
POLST forms and advance directives are documents that assist in advance care planning by helping to detail a patient’s wishes.
POLST forms complement advance directives by helping to translate the patient’s wishes and ensure continuity of care.
Another advantage of a POLST is that first responders can use them. A POLST can tell an EMT or other first responder whether the patient wants to receive CPR or hospitalization in the event that their condition suddenly worsens.
A healthcare proxy is someone appointed to make decisions about medical care on behalf of someone who cannot communicate. A POLST is a medical order detailing the person’s wishes regarding treatment.
Who Should Have a POLST / Healthcare Proxy?
The National POLST Coalition suggests that all adults can benefit from creating an advance directive. This lets a patient tell others what decisions they want made on their behalf if they can’t communicate. This can include the medical treatments they want and their values or religious beliefs.
On the other hand, a POLST is suited to anyone with a serious medical condition or risk factors for life-threatening medical events that makes them vulnerable, regardless of their age.
Having these documents in place lets you instruct healthcare providers on the specific treatments you want to receive during an emergency, across a multitude of different potential care settings.
POLST vs DNR
You may wonder whether a POLST can supersede or replace other types of medical orders, such as a do-not-resuscitate (DNR) Order.
POLST: More Information
Rather than replace or veto a DNR, a POLST can be a tool to help your care team identify your treatment preferences, including whether you wish to be resuscitated. A POLST provides all sorts of extra information to help emergency workers know what treatments to give.
Instead of automatically hospitalizing you or your loved one, a POLST can inform care personnel that your treatment preference is to be kept comfortable where you are.
As with a DNR, a POLST can inform emergency medical staff whether or not to administer CPR. DNR orders are only applicable when someone is unresponsive, has no pulse, and isn’t breathing.
In most medical emergencies, however, the individual will be breathing and have a pulse, or be responsive. This is where the key differences with a POLST come into play. A POLST can provide much more information to those administering emergency care than a DNR order can.
For example, a person’s POLST may inform emergency personnel that:
- You still want full treatment, meaning EMTs should take them to the hospital and consider all treatment options, including breathing machines.
- You want limited basic medical interventions, and don’t wish to be admitted to the intensive care unit (ICU).
- You don’t want to be hospitalized but would prefer to be made comfortable where you are.
POLST and Hospice Care
Never Call 911 or take a patient to the Emergency Room when they’re in hospice care.
This is counter-intuitive, especially when a patient is in distress. However, it’s important to call your hospice first. If they are unable to stabilize the patient, they can authorize ER/Hospitalization.
When a patient is admitted to the ER, they’ll be dismissed from hospice care and readmitted when they return.
Without prior approval, the patient will be 100% responsible for all costs relating to their hospital stay. This includes ER and hospital fees, diagnostic tests, medications, and ambulance charges.
Do You Need an Advance Directive to Have a POLST Form?
No, you don’t necessarily need an advance directive to have a POLST.
However, a POLST and an advance directive fulfill different functions and complement one another. Therefore, someone who uses one of these two directives should also use the other.
Before a physician or other health care professional fills out a POLST, they should ask their patient for a copy of their advance directive.
This lets the physician make sure the patient’s treatment wishes are aligned across both documents. The physician can then avoid creating confusion about the level of treatment to administer in an emergency.
How do an Advance Directive and a POLST Form Work Together?
Both forms can provide information about how you want to be treated in a medical emergency. The key to how these documents can work together is that a POLST is portable and can ensure continuity of care across different settings.
However, only an advance directive can name a healthcare proxy. A healthcare proxy can, if necessary, amend a POLST to change or augment a a patient’s treatment options.
Can You Use a POLST Form to Designate a Legal Surrogate?
No, you must use an advance directive to name your healthcare proxy or proxies. Once you’ve done this, the health care proxy (surrogate) can make decisions about their loved one’s care and the level of treatment they’ll receive.
Can a Health Care Proxy Override the Patient?
Potentially, yes.
Sometimes a healthcare proxy may wish to void or override a POLST. They may be aware that the person who can’t communicate changed their wishes regarding treatment before they had a chance to amend their POLST.
Depending on the state you live in, it’s sometimes possible for a healthcare proxy to amend or void a POLST.
Are you or a loved one living with a chronic or terminal illness?
The Sage Family of Companies is here to help.
Are you or a loved one living with achronic or terminal illness?
The Sage Family of Companies is here to help.
Advance Healthcare Planning
It’s generally a good idea for anyone over the age of 18 to consider putting an advance directive in place, even if they’re perfectly healthy.
Having an advance directive in place can relieve family and loved ones of the responsibility of making difficult decisions regarding care and clinical treatment. A POLST suits those with life-threatening conditions or risk factors.
To begin advance care planning:
Reflect on Your Values and What Matters to You
Doing this can help guide you in making decisions regarding care and treatment at the end of life, in the event of a medical crisis.
Discuss Advance Directives with a Healthcare Provider
Talking to a clinician can give you a helpful overview of your current health, and the kinds of decisions that you or a proxy may have to face. For example, you might ask your doctor about decisions likely to arise if your hypertension eventually leads to a stroke.
Advance care planning is covered by Medicare as part of an annual wellness consultation. If you have private health insurance, you should check with your insurance provider to see if advance care planning is covered.
Choose Someone to Appoint to Make Medical Decisions
It’s important to appoint someone you trust as a healthcare proxy, whether it’s a relative, partner, close friend, or professional, such as an attorney,
Once you’ve identified a trusted proxy, discuss any values and treatment preferences with them. If you aren’t ready to discuss specific treatments or care decisions yet, you can start with general preferences, or try other ways to communicate your wishes, such as writing a letter.
Complete Advance Directive Forms
A living will is a useful way to make care and treatment decisions official. Once you have selected who you want to act as your healthcare proxy, you can make your decision official by filling out a durable power of attorney for healthcare form.
Have a Doctor or Other Healthcare Provider Fill Out a POLST Form
Once your advance directives are in place and your healthcare proxy appointed, discuss your specific preferences for emergency care with your healthcare provider and have them fill out a POLST form.
Share Forms with the Relevant Parties
After completing advance directives, make copies to store safely. Give copies of these forms to health care proxy, doctor, and lawyer, if someone has one.
Some states have registries that can store advance directives so a person’s doctor or health care proxy can easily access them in an emergency.
Conclusion
A healthcare proxy is someone appointed to make decisions about medical care on behalf of someone who cannot communicate. A POLST is a medical order detailing the person’s wishes regarding treatment.
Understanding how these forms work and how to complete them can provide peace of mind and reassurance to a person and their loved ones that their wishes will be adhered to in the event of a medical crisis.
The Sage Family of Companies is here to answer any questions you may have.
Article resources:
- Advance care planning. (n.d.)
- Advance Care Planning: Advance Directives for Health Care. (2022).
- Advance directives. (2022).
- Comparing Advance Directives and POLST. (2020).
- Physicians Orders for Life-Sustaining Treatment (POLST) (n.d.)
- POLST program names. (2022)
- What is the difference between a POLST (Physician Orders for Life-Sustaining Treatment) and an advance healthcare directive? (2022).
