It’s a big problem. Actually, it is several big problems and Louisiana is trying to do something about it.
I will narrow it down to two problems:
1) Conversations between physicians and patients or their care givers about end-of-life care rarely happen or occur so late that they offer little guidance for the final weeks or months of a person’s life.
2) Patients who transfer between hospital, nursing home, assisted living, and home often are not accompanied with any instructions as to what the patient’s wishes might be for his/her care.
Louisiana is one of 16 states that have adopted a POST or POLST form. POST stands for Physician Orders for Scope of Treatment. POLST is Physician Orders for Life-Sustaining Treatment. I mention the Bayou State because I was just down there speaking.
BTW, I was expecting a slower pace of life in the sleepy Southern towns I was visiting — Covington, Madisonville, and Mandeville. They are at the northern end of the 24-mile Lake Ponchartrain Causeway. At the other end is New Orleans. I spent more time stuck in traffic than I do around my home in the Washington, DC suburbs. Evidently, the population in these little towns has mushroomed after 2005 and Katrina. I did find quiet in a park along the Tchefuncte River in Madisonville only to be caught in bumper-to-bumper, stop-and-go traffic for the mile going back into town to the four-way stop.
On the program, I followed Dr. Susan Nelson of Baton Rouge. She chairs the LaPOST Coalition and gave an overview of the Louisiana POST. Do yourself a favor and click here to go to the LaPOST Web site. Of the many resources on the site is a section on Religious Faiths and Cultural Heritages. Check it out for diverse views of illness and end-of-life care.
There is also a national Web site promoting POLST/POST at http://www.polst.org.
The common thread running through all the states’ initiatives is an encouragement of conversations among physicians, patients, and/or family members as one’s health declines. All have a standard form in each state that travels with the patient if they are transferred between facilities. The goal is not to limit medical treatments necessarily as one approaches the end of life. The goal is to encourage and make a record of the conversation between a doctor and those making health care decisions. Some may choose to limit life-prolonging procedures and others may want more aggressive care.
The point is to plan ahead and let others know what the goals of care are.
I commend Dr. Nelson and her colleagues for the excellent job they have done in service to the citizens of Louisiana.
Now. . . would you put traffic congestion as an agenda item at your next coalition meeting?