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Honoring End-of-Life Wishes

Many older adults know how they want to be treated at the time of a health emergency, however in many cases these wishes have not been documented or communicated.

For health emergencies, there are two important documents to consider: the POLST and the DNR.

POLST stands for Physical Orders for Life Sustaining Treatment

  • A medical form that is legally recognized in many U.S. states and specifically spells out the end-of-life treatments that someone does or doesn’t want. The POLST program in KS and MO is called TPOPP – Transportable Physician Orders for Patient Preferences.
  • It is a simple one-page document, printed on bright pink paper so it’s easy for EMTs and medical staff to recognize.
  • Medical professionals MUST follow the instructions on a POLST.
  • This document is usually recommended for terminally ill or very frail seniors who have made their end-of-life wishes clear.
  • It is not the same as an advance directive, a legal document used to provide guidance about types of treatments wanted in the case of a future, unknown medical emergency and may include the name of a surrogate to make medical decisions (aka living will or health care power of attorney).

DNR stands for Do Not Resuscitate

  • A signed medical order written by a doctor.
  • Tells health care providers and emergency medical personnel not to do CPR on an older adult if they stop breathing or if their heart stops beating.
  • It does not affect any other treatments, such as pain medicine, other medicines, or nutrition.

The primary difference between the POLST and DNR is that a POLST covers a variety of end-of-life treatments, whereas a DNR only gives instructions about CPR.

With a POLST, seniors can specify:

  • If they do or don’t want CPR
  • What type of life-prolonging medical interventions they’d want on top of comfort care, if any
  • Under what circumstances they would want to be moved to a hospital
  • If they would want a feeding tube and if so, for how long

With only a DNR, during an emergency, decisions about other interventions or treatments beyond CPR would be left to emergency responders or hospitals.

What happens without a DNR or POLST?

Without a DNR or POLST, hospitals and EMTs are required to do their best to resuscitate someone who is not breathing or doesn’t have a heartbeat. They can’t stop these efforts without a signed medical order. So, if your older adult doesn’t want those measures to be taken, they must have either a POLST or DNR.

How to get a DNR or POLST?

After understanding your older adult’s preferences, discuss their end-of-life wishes with their doctor.

Doctors should have access to the appropriate state forms for POLST or DNR and they must sign the form to make it official.

It is essential to use a form that’s legally recognized in your older adult’s state.

What to do with the POLST or DNR form?

Make sure the DNR or POLST is easily accessible… these documents can only be honored if people know they exist.

Make sure doctors, nurses, caregivers, family members, hospitals, and assisted living staff know about your older adult’s wishes and that the ORIGINAL form is on file and/or posted prominently in your senior’s room near their bed or on their refrigerator – EMTs are likely to look there. Obtaining several original versions of the form is recommended so that they can be distributed to all who may need them.

More information:

For more information on TPOPP in KS/MO, please watch this video.

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