subject: New End-of-life Study Has Implications For California Seniors [print this page] A study appearing in the July issue of the Journal of the American Geriatrics Society indicated that nursing home patients who participated in a program that allowed them to record their end-of-life request were much more likely to have their preferences fulfilled.
It is important for seniors to understand that in order to receive the health care services they want, they must communicate this information in advance of any life-threatening situation, suggests Alan Weinstock, insurance broker at www.MedicareSupplementPlans.com.
Physician Orders for Life-Sustaining Treatment (POLST)
POLST allows the terminally ill or nursing home patients to specify the type of end-of-life care they prefer. A new study found that those with a POLST were 59% less likely to get unwanted hospitalizations and medical interventions.
For instance, the study found that 95% of people with a POLST got the medical interventions they wanted as it related to antibiotics, compared to only 3% of those without a POLST. And for the use of feeding tubes it was 96% versus 6%.
Obviously having clear, specific end-of-life wishes in place puts patients in a much better position to have their preferences fulfilled, remarks Alan.
Patients have Concerns about POLST
While there are about 250 nursing homes, hospitals and other health care facilities in the state of California that have adopted POLST, there has been some resistance from patients. Some patients are concerned that a doctor might override their wishes, and others worried that if they didnt request full lifesaving treatment, their overall care would decline.
Unfortunately, there appears to be a perception that health care facilities only implement POLST as a cost-savings technique. However, several doctors stressed that it is intended to be a process by which they can honor the request of their patients.
Medicare, POLST and Hospice
The Affordable Care Act (ACA) mandates that a physician or nurse practitioner (NP) have a face-to-face encounter with certain long-stay hospice patients. The proposed implementation of this requirement is included in the "Home Health Prospective Payment System Rate Update for Calendar Year 2011" proposed rule.
Recent reports indicate that the average time spent in hospice is falling while hospitalizations during the last six months of life are on the rise as doctors practice what has been termed as exhaustive medicine, treating until there are no more options left to try. One large study of Medicare records found that nearly 12% of cancer patients who died in 1999 received chemo in the last two weeks of life, up from nearly 10% in 1993.
Regardless of whether a patient is in hospice, is a Medicare beneficiary or faces some other life-threatening health care situation, having a POLST could help to clarify a patients final wishes.
