My husband was clearly losing his independence after a terminal diagnosis and many hospital visits. I was getting more and more responsibility, which I didn’t mind, but the best way we could handle it was just to let it happen. There was no way to stop it, so we just had to live with it. The changes were slow in coming, and eventually, my being responsible for everything just fell into place. There was no choice; it just had to be that way. We then decided that I would have Bill’s power of attorney, be sure his advance care directives were up to date, and add a new form called POLST.
- Power of attorney, or POA, gives permission to another person, known as your agent, to act on your behalf in legal matters.
- It can be a general power of attorney, or general POA, granting broad power over your affairs.
- It can be a special power of attorney, or special POA, allowing your agent power only over specific situations.
- This includes writing checks, signing official documents, or handling other legal dealings.
- Your agent does not need to be a lawyer. It can be your spouse or any person over the age of 18 you choose.
- You can also choose to make a durable power of attorney, meaning your agent’s powers remain in effect if you become incompetent or incapable of handling your affairs.
Getting a power of attorney is a big decision. We chose to get one as I was taking over more and more of the duties and felt it was important. If Bill were to become incapacitated, I could continue taking care of our finances and make all necessary decisions without any fuss or legal issues. If you choose to initiate a power of attorney, you can prepare the document yourself; you can even find the forms online. You do not have to use a lawyer.
We also had in Bill’s medical record an advanced health care directive. It is the best way to ensure your wishes are followed regarding your health if you cannot speak for yourself, by appointing another person to be your health care “agent.” This person will have the legal authority to make decisions about your medical care if you become unable to make decisions for yourself. Your doctor must abide by your wishes when this form is signed by you and filed in your medical record.
The final form we had at home was called a POLST form. It is bright pink, and we were told to place it on the refrigerator, where an ambulance driver would look for it. POLST means Physician Orders for Life-Sustaining Treatment.
Your physician must sign this form after you have checked the type of treatment you would want if you became ill and an ambulance needs to take you to the hospital. It is in lieu of your medical record because they don’t have it available. This directive must be followed and is in complement to your advance directive but does not replace it.
The ambulance driver would take it with them when they transported the patient. It is their “orders” on how to treat or not treat the patient in the ambulance.
Three areas are addressed on the form:
A: Two choices:
- Attempt resuscitation: CPR.
- Do not attempt resuscitation: CPR.
B: There are three choices for treatment:
- Full treatment: the primary goal is to prolong life by all medically effective means.
- Selective treatment: the goal is to treat medical conditions while avoiding burdensome measures.
- Comfort-focused treatment: the goal is to maximize comfort only.
C: Three choices for artificially administered nutrition:
- Long-term artificial nutrition, including a feeding tube.
- Trial period of artificial nutrition, including a feeding tube.
- No artificial means of nutrition, including a feeding tube.
D: Information and signatures:
- The doctor and the patient sign the form. A copy of it is then placed in the patient’s medical record.
- If a section is left blank, it is implied that the patient wants the full listed treatment.
I sent Bill to the hospital in an ambulance one night when he had chest pain, and the EMTs took the form with them, as they are supposed to, yet it was not given back to Bill when it was time for discharge. That meant we had to go to the doctor to fill out a new form. At first, I thought it was just a lot of trouble, but it turned out to be a good idea. The patient’s condition may have changed while they were in the hospital, and new decisions might need to be made.
All these forms will give you peace of mind while dealing with a long-term illness. They allow the patient to help make the decisions while they are feeling well enough to consider all ramifications. For the caregiver, it helps them know they are following the patient’s desires regarding health care, finances, and death and dying.
Nancie Wiseman Attwater is the author of A Caregiver’s Love Story.