Improving End-of-Life Communication through the new POLST Act
by Shana Siegel, CELA*
Studies have found that New Jersey patients near the end of life receive more aggressive treatment than patients in other states. Nearly 25 percent spend a week or more in the intensive care unit in their last six months, compared with the national average of 15 percent. This may be in part because most New Jerseyans have not prepared advance directives.
Recently passed legislation is aimed at changing this. On December 21, 2011, Governor Christie signed the Physician Orders for Life-Sustaining Treatment Act (“POLST Act”). The POLST Act is designed to make patient’s wishes concerning end-of-life treatment known in advance. The POLST legislation encourages patients diagnosed with a terminal illness to write an end-of-life plan, expressing specific goals for their remaining days.
While as few as 15% of New Jerseyans have executed advanced directives, even such documents are not effective if not accompanied by a meaningful discussion of the individual’s wishes and as stated in the POLST bill "simply…name an individual to make healthcare decisions . . . and are often locked away in file drawers or safe deposit boxes and unavailable to health care providers."
The POLST Act is designed to facilitate conversations between patients and doctors about what patients want if they are no longer able to voice their preferences. Unlike advance directives, POLSTs must be signed by a physician (or advanced practice nurse) and either the patient or their health proxy or legal guardian. POLST carries the authority of a medical order. It becomes part of the patient's medical record and is designed to follow the patient from one healthcare setting to another: home, ambulance, hospital, nursing facility, rehabilitation hospital, long-term care, hospice. A POLST can be revoked or changed by the patient, and the patient can choose whether to give that authority to his or her health care proxy.
The New Jersey POLST form has been designed to focus on patient goals and avoid the stark juxtaposition between "full treatment" and "comfort care only." This may help alleviate the hesitancy of many physicians and families to consider hospice until death is imminent. In New Jersey, patients get referred later to hospice than in other states, spending an average of 17 days in hospice, as compared to the national average of 26 days. This makes it more difficult for families and patients to get the comfort and support they need.
The POLST Act cannot solve all end-of-life conflicts. However, it is one more tool to facilitate communication between patients, families and health care providers. And that is ultimately the best way to ensure patient wishes are honored.
WANDERPOLO LAW LLC
TAILORED ESTATE & ELDER LAW PLANNING
info@wanderpololaw.com • www.wanderpololaw.com
The Livery Building • 209 Cooper Ave., Suite #2 • Upper Montclair, NJ 07043
(973) 744-5710 phone • (973) 744-0211 fax
* Certified as an Elder Law Attorney by the A.B.A. approved National Elder Law Foundation.
