What Is The Difference Between A Health Care Directive And A POLST Form?

This question is one that many patients and their families ask. Even though a Health Care Directive and a Physician Orders for Life-Sustaining Treatment (POLST) form deliver similar instructions, it is important to know the particulars of both.

A Health Care Directive is a unique legal document that provides individuals and those close to them with peace of mind in the event of unforeseen circumstances like a car accident or a fall. If a person becomes incapacitated and is no longer able to communicate wishes for his or her health or personal care, a Health Care Directive allows him or her to convey treatment preferences to doctors and to appoint a Health Care Agent to act on his or her behalf. It is smart for all adults to have one prepared to ensure that their wishes are followed medically. Keep in mind that Health Care Directive laws and the definitions of key medical terms vary from state to state, which makes it particularly helpful to meet with an Elder Law attorney to ensure that your Health Care Directive has been drafted and executed properly.

A POLST form is different than a Health Care Directive primarily because it must be written and signed by a physician. When filling out the form, doctors converse directly with their patients and record directions about what to do if they become unable to speak for themselves. Examples of topics that doctors and patients discuss are who should make medical decisions on behalf of the patient (if a Health Care Agent has not already been appointed) and whether or not to attempt life-sustaining measures, such as CPR after cardiac arrest. While Health Care Directives are prepared in advance of medical issues, POLST forms are completed when a new critical medical condition arises or when changes to a current condition take place.

What makes a POLST form particularly useful is its ability to give end-of-life instructions when no Health Care Directive is available. However, those with a Health Care Directive can also complete a POLST form with their doctor since it adds more detail to the guidelines already established. Plus, POLST forms are easily recognizable – the doctors, nurses, and other medical professionals attending to patients can quickly navigate and spot the key information on the document.

For general information about Health Care Directives from the Minnesota Department of Health, visit www.health.state.mn.us/divs/fpc/profinfo/advdir.htm. If you would like more information about POLST forms, check out www.polst.org. To learn about state-specific laws and terms or to draft a Health Care Directive, be sure to consult with an Elder Law attorney.

Building Your Team

By Joy Gullikson and Michelle Fournier

Joy E. S. Gullikson

Having a team of experts to call on is sound planning, no matter what your age or health condition. The older or less independent you are, the more important this planning becomes. Everyone needs experts they can call on to help with their legal, financial, tax, medical, real estate, and even pet and vehicle issues. Ideally, these experts will have your best interests at heart, will recognize issues outside their own areas of expertise and make referrals, and will work with each other to provide the best care possible.

For example: John Doe suffers from severe diabetes, lives alone, has investments with three different investment houses, banks at two different banks, drives an old Chevy and has a 10 year old cat. John wants to sell his home and move into an assisted living facility. He doesn’t want to talk to his son, because John is afraid to worry him. Eventually, John hears of an assisted living place through friends and decides to move. John must pay the down payment so he calls one of his banks, but there was no one available to listen to his story and help him develop a plan. John withdraws money from two investment accounts to come up with the entrance fee, incurring a substantial tax impact. John hires movers, and once in his assisted living, must move the furniture around himself to fit it all in. As John moves in, he is told that he needs to get rid of his cat. John is exhausted, broke and devastated that he will lose his pet.

If John had a team in place the story would be different. He would call his elder law attorney who would put him in touch with the firm’s care manager. The care manager would work with John to find a place that he likes, can afford, and allows pets. John’s financial advisor would work with John to find the entrance fee funds that would cause the least tax burden and help John appropriately invest the funds from the sale of his home (using a realtor recommended by one of his team). The care manager would also find John a mover who would not only take care of the move but also the set up in his new apartment. Once in his new apartment, John would call on his veterinarian, who makes house calls, to provide John’s cat with the care needed. John’s experts identify other services that will come to John. Soon John feels he no longer needs his car. He contacts his trusted mechanic who sells the car for a good price. Thanks to the efforts of John’s team, the process of change is smoother, simpler, and ultimately less expensive than the first.

5 Steps to Building a Good Team:

1. Build your core team. The core team include your lawyer, health care professional and financial advisor. Find these people early, establish a rapport with each of them and ensure that each expert will work with the others.

2. Identify other team members you may need. If you have a pet, you may need a veterinarian who makes house calls. If you have hearing loss, you may need a mobile audiologist.

3. Build your team before you need to make life altering decisions. The earlier you have a team of people who know you, your desires and your needs, the smoother decision making will be in the event changes need to happen quickly or if a crisis occurs.

4. Don’t be afraid to ask your team for help outside their area of expertise. If your lawyer, whom you trust, trusts a certain real estate agent, chances are you will trust that agent as well.

5. If you are tired, turn the management of your team over to a trusted family member, whom you know has your best interests at heart. A son or daughter whom you know to be competent will usually be glad to make sure that your needs are met. Having a good team in place will make the job much easier for your child, rather than having to make guesses about what to do.

Planning and gathering a trusted team will ensure your life plan is as smooth as possible.

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