Plan Before Panic

In our 25 years of involvement in home care, we are frequently called by family members who require care for their loved ones after an unexpected illness or injury. In these instances, concerned friends and family members may not have taken the time to explore or understand what is available in terms of home care, and these life-changing decisions may be made in panic mode. Whether or not your family has set up a trust or taken out a long-term care policy, someone needs to take the responsibility for deciding who will care for mom or dad. This individual will need to consider the following:

1.      The need for a dual power of attorney for the patient’s health care and fiduciary matters.

2.      An understanding of the patient’s wishes when they are unable to decide for themselves.

3.      The need to decide which family member will be responsible for paying the household bills when the patient can’t do it themselves.

4.      The need to decide which family member will determine whether the patient will stay in the home, go to assisted living or a skilled nursing facility.

5.      An understanding of what resources are available to the patient: an acute care hospital, a skilled nursing facility, assisted living, memory care, hospice care or a home care agency.

A POLST (Physician Orders for Life-Sustaining Treatment) form is available from a health care provider and specifies what kind of care a seriously ill patient desires. This document is signed by both the physician and patient and goes with the patient, whether in the home or to a facility.  A POLST form indicates the treatment options chosen by the patient. These may include:

·         Resuscitation, including CPR, a defibrillator, intubation or a ventilator;

·         DNR (Do Not Resuscitate) order;

·         Comfort Measures, including pain management;

·         Antibiotics to fight off infections, including pneumonia;

·         Intravenous (V) Fluids;

·         Artificial Nutrition/Tube Feeding.

An Advance Health Care Directive specifies who speaks on behalf of the patient (i.e., power of attorney), general health care decisions, organ donation information and the choice of a primary care physician.  The primary difference between the two documents is that a POLST deals with end-of-life issues and brings up the difficult decisions that many patients and family members may want to avoid. These decisions need to be made well before the need arises so that all parties involved are operating from a calm, clear and rational perspective as opposed to crisis mode.

Feel free to call our office at (707) 538-0679 and talk with our case management team to explore the options available in a home care setting.