The NHPCO explains the differences between POLSTs and Advance Directives

A POLST is a part of the advance care planning process and communicates your wishes as medical orders. A POLST form consists of a set of medical orders that applies to a limited population of patients, such as seriously ill or frail persons, and addresses a limited number of critical medical decisions. A POLST has the option of specifying Do Not Resuscitate (DNR) but also makes provision for other types of treatment such as feeding tubes and mechanical ventilation. They will be filled out in consultation with your doctor.

What is a POLST?

A POLST communicates your wishes as medical orders, and so is prepared together with your doctor who will sign it. POLST’s have different names in different states, but all have the force of medical orders. POLST’s are specifically for the seriously ill or frail. POLST’s can travel with you and are honored by emergency medical technicians.

How is a POLST different from an advance directive or DNR (do not resuscitate)?

• POLST = Portable Medical Orders.  Different states use different names such as POLST, POST, MOLST, MOST, etc. for their programs.
• POLST is for people who are seriously ill or have advanced frailty. If you are healthy, an advance directive is for you. POLST forms and advance directives are both parts of advance care planning but they are not the same.
• POLST forms must be filled out and signed by a health care provider. When you need a prescription, you go to your provider who writes or types an order for your prescription and signs it. POLST is a medical order so it is the same: you need to go to your health care provider who will write out the POLST and sign it. The difference with POLST is that you should have a good talk with your provider about what you want considering your current medical condition: What is likely to happen in the future? Treatment options? You’ll also be asked to sign your POLST form.
• POLST forms tell other providers what you want. During a medical emergency, if you can talk, providers will ask you what you want. POLST forms are used only when you cannot communicate and you need medical care. When that is the situation, the POLST form orders providers to give you the treatments you chose.
• POLST forms are out-of-hospital medical orders. This means that they are medical orders that travel with you. Wherever you are, your POLST form tells health care providers what treatments you want and your goals of care, even if you transfer from hospital to nursing home, back to your home, or to hospice or another setting.
• POLST is voluntary. You make the choice about having a POLST form: you should never be forced to have one! If you are healthy, however, your provider may choose not sign a POLST form for you since it was designed for people who are seriously ill or have advanced frailty (some state laws do not allow providers to sign a POLST form unless you are seriously ill or have advanced frailty).
• Advance Directives:  POLST’s give specific directions about treatments during an emergency if you cannot speak for yourself. However, POLSTs do not appoint someone to speak on your behalf which Advance Directives generally do. In a POLST, you specify exactly what you want and don’t want and for how long. They have the force of medical orders and must be honored by emergency medical technicians (EMT’s). EMT’s cannot honor advance directives or medical powers of attorney. Once emergency personnel have been called, they must do what is necessary to stabilize a person for transfer to a hospital, both from accident sites and from a home or other facility. After a physician fully evaluates the person’s condition and determines the underlying conditions, advance directives can be implemented.
• Do Not Resuscitate (DNR’s):  A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs healthcare providers not to do cardiopulmonary resuscitation (CPR) if a patient’s breathing stops or if the patient’s heart stops beating. If presented, it will be honored by EMT’s. A POLST has the option of specifying DNR but also makes provision for your choices around resuscitation and other types of treatment such as feeding tubes and mechanical ventilation.

How do you find the POLST for your state?

You may want to review your state’s form before you meet with your doctor. The National POLST website has lots of information on POLSTs in general and you will be able to find and review the one from your state. 

The NHPCO answers some FAQs about how Hospice Care is paid for:

How is Hospice Care Paid For?

Hospice is most often paid for as a defined benefit of Medicare. However, hospice may also be paid for as part of a Medicare Advantage plan, by state Medicaid plans, or, in the case of children and others covered by private insurance, by private insurance. There may be different services covered by different sources of payment, so be sure to discuss the source of payment and the services that are covered with your hospice team.

Medicare and Medicaid

Medicare covers hospice care costs through the Medicare Hospice Benefit, which you can read about at Medicare.gov. If you’re in a Medicare Advantage Plan or other Medicare health plan, once your hospice benefit starts, Original Medicare will cover everything you need related to your terminal illness. Original Medicare will cover these services even if you choose to remain in a Medicare Advantage Plan or other Medicare health plan.

Veterans’ Administration (VA) benefits also cover hospice care.

The coverage of hospice care by Medicaid is optional and varies by state so be sure to read up at Medicaid.gov.

Private insurance

Many work-based and private insurance plans provide at least some coverage for hospice care. It’s best to check with your insurance company because there are different types of plans available that may or may not cover hospice services. There are also different ways a person can be considered eligible for hospice care and what costs are covered can vary based on the health plan you have.

Uninsured

For people who are not insured, or who may not have full coverage for hospice services, some hospice organizations may offer care at no cost or at a reduced rate based on your ability to pay. They can often do this because of donations, grants, or other sources. Nearly all hospices have financial support staff who can help you with this, answer your questions, and help you get the care you need.

News from the National Hospice and Palliative Care Organization:

Research Shows Hospice Produces Better Outcomes, Lower Medicare Costs

(Washington, D.C. and Alexandria, VA) – On Thursday, July 27, 2023, a panel of healthcare experts presented groundbreaking new research at a Capitol Hill briefing for Congressional offices, showing that patient use of hospice contributed to $3.5 billion in Medicare savings in 2019, while also providing multiple benefits to patients, families, and caregivers.

The study, conducted by NORC at the University of Chicago, is one of the most comprehensive analyses of enrollment and administrative claims data for Medicare patients covered by Medicare Advantage and Traditional Medicare. The study was funded by the National Association for Home Care & Hospice (NAHC) and the National Hospice and Palliative Care Organization (NHPCO).

Panelists Dianne Munevar, VP of Health Care Strategy at NORC; Dr. Joseph Shega, Chief Medical Office at Vitas; and Susan Lloyd, CEO of Delaware Hospice, related their vast experience with hospice care, extolling its benefit for patients and their loved ones, and also shared findings which prove that longer hospice stays equate to greater savings for taxpayers and overall, better experiences for patients.

Susan Lloyd, CEO of Delaware Hospice shared her personal experience with her mother’s end of life care. “The full benefits of hospice care are realized when the patient and family have the opportunity to engage with the team who provides the support needed wherever [the patient] calls home. Hospice is not a place, it’s a way of caring for people and their loved ones as they are nearing the end of life,” said Lloyd. “One of the greatest blessings of my life was to be there when my mom died. She was not alone; she was surrounded by love. Hospice made that happen for mom, for me, and my family.”

“There’s a lot of myths and misperceptions about what hospice is and what hospice does because of short stays,” said Dr. Joseph Shega, Chief Medical Officer of VITAS. “So when you have a short stay, the hospice does incredible work to try to meet [patients] where they are to honor their wishes […] but if somebody would have that conversation four, five, six, months earlier, they could have an experience like what Jimmy Carter is experiencing now, where he’s chosen he wants to be at home and there’s no difference in life expectancy between those who enroll in hospice earlier vs. those who don’t. With hospice, you can provide that care at home.”

Key findings from the Value of Hospice study include the following:

• NORC estimates that Medicare spending for those who received hospice care was $3.5 billion less than it would have been had they not received hospice care.
• In the last year of life, the total costs of care to Medicare for beneficiaries who used hospice was 3.1 percent lower than for beneficiaries who did not use hospice.
• Hospice is associated with lower Medicare end-of-life expenditures when hospice lengths of stay are 11 days or longer. In other words, earlier enrollment in hospice reduces Medicare spending even further.
• Hospice stays of six months or more result savings for Medicare. For those who spent at least six months in hospice in the last year of their lives, spending was on average 11 percent lower than the adjusted spending of beneficiaries who did not use hospice.
• At any length of stay, hospice care benefits patients, family members, and caregivers, including increased satisfaction and quality of life, improved pain control, reduced physical and emotional distress, and reduced prolonged grief and other emotional distress.

Hospice care focuses on quality of life when a cure is no longer possible, or the burdens of treatment outweigh the benefits. Some people think that their doctor’s suggestion to consider hospice means that death is very near. That is not always the case at all. People often don’t begin hospice care soon enough to take full advantage of the help it offers.

In the United States, people enrolled in Medicare can receive hospice care if their doctor thinks they have fewer than six months to live should their disease take its usual course. Doctors have a hard time predicting how long a person will live. Health often declines slowly, and some people might need a lot of help with daily living for more than six months before they die.

Talk with your doctor if you think a hospice program might be helpful. If they agree, but think it is too soon for Medicare to cover the services, then you can investigate other ways of paying for the services.

What happens if someone under hospice care lives longer than six months?

Hospice care can be initiated and continued so long as your doctor believes you likely have fewer than six months to live.

Sometimes, people receiving hospice care live longer than six months and the care can be extended. You can get hospice care for two 90-day benefit periods, followed by an unlimited number of 60-day benefit periods.

It is also possible to leave hospice care if a patient’s condition improves or they decide they wish to resume curative care and return to hospice care later.

What are the differences between each type of care?

The Focus:

Palliative: Palliative care is not hospice care: it does not replace the patient’s primary treatment; palliative care works together with the primary treatment being received. It focuses on the pain, symptoms and stress of serious illness most often as an adjunct to curative care modalities. It is not time limited, allowing individuals who are ‘upstream’ of a 6-month or less terminal prognosis to receive services aligned with palliative care principles. Additionally, individuals who qualify for hospice service, and who are not emotionally ready to elect hospice care could benefit from palliative services.

Hospice: Hospice care focuses on the pain, symptoms, and stress of serious illness during the terminal phase. The terminal phase is defined by Medicare as an individual with a life expectancy of 6-months or less if the disease runs its natural course. This care is provided by an interdisciplinary team who provides care encompassing the individual patient and their family’s holistic needs.

Who Can Receive Each Type Of Care?

Palliative: Any individual with a serious illness, regardless of life expectancy or prognosis, can receive palliative care.

Hospice: Any individual with a serious illness measured in months not years can receive hospice care. Hospice enrollment requires the individual has a terminal prognosis.

Can The Patient Still Received Curative Treatments?

Palliative: Yes, individuals receiving palliative care are often still pursuing curative treatment modalities. Palliative care is not limited to the hospice benefit. However, there may be limitations based on their insurance provider.

Hospice: The goal of hospice is to provide comfort through pain and symptom management, psychosocial and spiritual support because curative treatment modalities are no longer beneficial. Hospice should be considered at the point when the burden of any given curative treatment modalities outweighs the benefit coupled with prognosis. Other factors to consider and discuss, based on individual patient situations, are treatment modalities that no longer provide benefit due to a loss of efficacy.

How Long Can An Individual Receive Services?

Palliative: Palliative care is not time-limited. How long an individual can receive care will depend upon their care needs, and the coverage they have through Medicare, Medicaid, or private insurance. Most individuals receive palliative care on an intermittent basis that increased over time as their disease progresses.

Hospice: As long as the individual patient meets Medicare, Medicaid, or their private insurer’s criteria for hospice care. Again, this is measured in months, not years.

Medicare is the federal health insurance program for:

-People who are 65 or older

-Certain younger people with disabilities

-People with End-Stage Renal Disease

The different parts of Medicare help cover specific services.

Medicare Part A (Hospital Insurance): Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some health.

Medicare Part B (Medical Insurance): Part B covers certain doctors’ services, outpatient care, medical supplies, and preventative services.

Medicare Part D (Prescription Drug Coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines).

With Medicare, you have options on how you get coverage. There are two main ways:

Original Medicare: Original Medicare pays for much, but not all, of the cost for covered healthcare services and supplies.

Medicare Advantage: Medicare Advantage is an “all in one” alternative to Original Medicare. These “bundled” plans include Part A, Part B, and usually Part D.

It’s important to get to know more about Medicare options before you decide how to receive your coverage. More detailed information on Medicare can be found at Medicare.gov

National Nurses Week is celebrated annually from May 6, also known as National Nurses Day, through May 12, the birthday of Florence Nightingale, the founder of modern nursing.

“Dependable, trustworthy, caring,
Living for others, loving, sharing.
At times wondering “Why am I a Nurse?
Is it a Blessing or maybe a curse? “

Because, at times, Nurses are not appreciated,
For the work to which their life is dedicated.
However, Nurses know their job is worthwhile,
when, after a hard day, a patient will smile.”
—Excerpts from a poem by an author who simply calls herself Carlotta and a retired R.N with 41 yrs experience.

So just what is the definition of “nurse” and how did it arrive? Nursing has been called the oldest of arts and the youngest of professions. The history of nursing walks hand in hand with woman herself; but of course the meaning of the word nurse has changed over the course of centuries. The word nursing is derived from the Latin nutrire “to nourish” with its roots in the Latin noun nutrix which means “nursing mother” (This referring to a wet nurse who breast fed the babies of others). The original meaning of the English word was first used in English in the 13th century and its spelling underwent many forms, norrice, (from the French version of nourrice-a woman who suckled a child) nurice or nourice, to the present day, nurse.

By the 16th century the meanings of the noun included “a person, but usually a woman who waits upon or tends to the sick”. Two more components were added during the 19th century; training of those who tend to the sick and the carrying out of such duties under direction of a physician.

Women, because of maternal instincts, were considered “born nurses”. The parental instinct, however, is present in both sexes of all races. It is thought that women present a greater degree of this due to their traditional role in the family. “Yet the spirit of nursing has no sexual boundaries. Human beings of both sexes have a natural tendency to respond to helplessness or a threat to life from disease or injury.”- Donahue, 1996

In our ancient times, a woman cared for her own family. This expanded to taking care of members in her own tribe. As early civilizations progressed, so did nursing as it began to be performed outside the home. This development led to the inclusion and concentration on additional elements: skill, expertise, and knowledge. So as man learned more and more about disease, illnesses, and treating the injured, nursing evolved to become both a nurturing art and a science.

It is why today the head, the heart, and the hands have united to become modern day nursing’s foundation.
In 1971, a nursing theorist by the name of Joyce Travelbee declared, “A nurse does not only seek to alleviate physical pain or render physical care – she ministers to the whole person. The existence of suffering, whether physical, mental or spiritual is the proper concern of the nurse”. (Travelbee, 1971).

The following is a Brief History of National Nurses Week

1953 Dorothy Sutherland of the U.S. Department of Health, Education, and Welfare sent a proposal to President Eisenhower to proclaim a “Nurse Day” in October of the following year. The proclamation was never made.

1954 National Nurse Week was observed from October 11 – 16. The year of the observance marked the 100th anniversary of Florence Nightingale’s mission to Crimea. Representative Frances P. Bolton sponsored the bill for a nurse week. Apparently, a bill for a National Nurse Week was introduced in the 1955 Congress, but no action was taken. Congress discontinued its practice of joint resolutions for national weeks of various kinds.

1972 Again a resolution was presented by the House of Representatives for the President to proclaim “National Registered Nurse Day.” It did not occur.

1974 In January of that year, the International Council of Nurses (ICN) proclaimed that May 12 would be “International Nurse Day.” (May 12 is the birthday of Florence Nightingale.) Since 1965, the ICN has celebrated “International Nurse Day.”

1974 In February of that year, a week was designated by the White House as National Nurse Week, and President Nixon issued a proclamation.

1978 New Jersey Governor Brendon Byrne declared May 6 as “Nurses Day.” Edward Scanlan, of Red Bank, N.J., took up the cause to perpetuate the recognition of nurses in his state. Mr. Scanlan had this date listed in Chase’s Calendar of Annual Events. He promoted the celebration on his own.

1981 ANA, along with various nursing organizations, rallied to support a resolution initiated by nurses in New Mexico, through their Congressman, Manuel Lujan, to have May 6, 1982, established as “National Recognition Day for Nurses.”

1982 In February, the ANA Board of Directors formally acknowledged May 6, 1982 as “National Nurses Day.” The action affirmed a joint resolution of the United States Congress designating May 6 as “National Recognition Day for Nurses.”

1982 President Ronald Reagan signed a proclamation on March 25, proclaiming “National Recognition Day for Nurses” to be May 6, 1982.

1990 The ANA Board of Directors expanded the recognition of nurses to a week-long celebration, declaring May 6 – 12, 1991, as National Nurses Week.

1993 The ANA Board of Directors designated May 6 – 12 as permanent dates to observe National Nurses Week in 1994 and in all subsequent years.

1996 The ANA initiated “National RN Recognition Day” on May 6, 1996, to honor the nation’s indispensable registered nurses for their tireless commitment 365 days a year. The ANA encourages its state and territorial nurses associations and other organizations to acknowledge May 6, 1996 as “National RN Recognition Day.”

1997 The ANA Board of Directors, at the request of the National Student Nurses Association, designated May 8 as National Student Nurses Day. –American Nurses Association.

The Florence Nightingale Pledge

I solemnly pledge myself before God and presence of this assembly; To pass my life in purity and to practice my profession faithfully.

I will abstain from whatever is deleterious and mischievous
and will not take or knowingly administer any harmful drug.

I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in the practice of my calling.

With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care.

Happy Nurses Week to all nurses and thank you for choosing nursing!

Published by: National Hospice and Palliative Care Organization

National Healthcare Decisions Day is on Sunday, April 16, 2023, and is dedicated to inspire, educate and empower the public about the importance of advance care planning.

Advance care planning involves making future healthcare decisions that include much more than deciding what care you would or would not want; it starts with expressing preferences, clarifying values, identifying health care preferences and selecting an agent to express healthcare decisions if you are unable to speak for yourself.

National Healthcare Decisions Day is a collaborative effort of national, state and community organizations committed to ensuring that all adults with decision-making capacity in the United States have the information and resources to communicate and document their future healthcare decisions.

In honor of National Healthcare Decisions Day, NHPCO encourages everyone to:

Have A Conversation

Advance care planning starts with talking with your loved ones, your healthcare providers, and even your friends- all are important steps to making your wishes known. These conversations will relieve loved ones and healthcare providers of the need to guess what you would want if you are ever facing a healthcare or medical crisis.

Complete Your Advance Directive

“Advance Directives” are legal documents (Living Will and Healthcare Power of Attorney) that allow you to plan and make your own end-of-life wishes known in the event that you are unable to communicate.

Engage Others in Advance Care Planning

Please pass along brochures, information and advance directives to others in your family, workplace and community. Help others have a conversation about advance care planning.

“National Healthcare Decisions Day exists to inspire, educate and empower the public and providers about the importance of advance care planning.”

Remember….. Your Decisions Matter!

Many of us know someone who is a caregiver. Do you know someone who spends time providing physical, emotional or practical support to a family member or friend? Many caregivers feel alone, helpless, confused, unprepared, tired and unable to provide for the needs of their family member or friend. Often, people caring for another need help and do not know how to ask for it. There are many ways to help support a caregiver…

Ask the caregiver how they are doing:

Let them know you respect their privacy, but care about
them and want to offer support and a listening ear.

Reach out to caregivers with a touch, a hug, or other physical expression of support:

Supportive human contact is important and can be very meaningful to someone who is caregiving and experiencing the many losses that accompany being a caregiver. However it is always important to check with the caregiver to make sure they are okay with being touched.

Spend time with the person who is sick or injured:

Family caregivers are often the only link the care receiver has with the outside world. Offering to spend time with the person can be a gift to both the care receiver and caregiver. Bring a book or newspaper to read aloud, a game to play, photos to share or just a friendly ear for a conversation.

Offer specific help:

Saying “call me if you need me” is vague and may not appear to be a sincere offer for help. Often caregivers do not want to be a bother or may not feel they have the time to make a call, as it is one more thing for them to do. Be specific, ask the caregiver if you can go shopping, make a phone call, cook a meal or sit with the person who is ill. By offering to do something specific, you are communicating that you are really willing to help the caregiver.

Tell the caregiver it is okay to take a break from their caregiving role:

You can let them know that it is okay to take time to renew themselves; they deserve it and need to care for themselves in order to continue providing care.

Karen Ann Quinlan Hospice – Let us help.

The vast majority of Americans say what they want at the end of life is to die in their own homes, as comfortable and pain-free as possible. The hospice philosophy is about making sure that a patient’s death experience reflects their wishes. Here are five ways that Karen Ann Quinlan Hospice helps to deliver this.

We give you comfort. The staff at Karen Ann Quinlan Hospice are experts at managing life-limiting illness. Our team ensures that medication, therapies and treatments all support a care plan that is centered on the patient’s goals. And our services can be offered wherever the patient calls home, allowing friends and family to visit freely; something they might not be able to do in a hospital ICU setting.

Hospice gives you peace. Beyond physical relief, Karen Ann Quinlan Hospice strives to help patients and families find emotional and spiritual comfort during what is often a very traumatic time. We are able to provide families with counselors, therapists, spiritual care advisors and bereavement professionals who can best support their struggles with death and grieving. These services are part of the hospice benefit, covered by Medicare, Medicaid or most private insurances

Hospice gives you something extra. Hospice is not only about compassionate medical care and control of pain. Pet therapy and massages are offered in addition to many other programs.

Hospice gives caregivers guidance. Most families are not prepared to face the death of a loved one. In addition to caring for patients, Karen Ann Quinlan Hospice also offers services for families and loved ones that provide emotional support and advice to help family members become confident caregivers and adjust to the future with grief support for up to a year.

Karen Ann Quinlan Hospice gives you more. Be it more joy, more love, or more quality of life in general, the goal of Karen Ann Quinlan Hospice is to offer patients the ability to enjoy the time they have remaining, and create meaningful memories for their families.