Creative, combined care plan provides best of both worlds

Q: I'd like to share a care alternative that I haven't seen mentioned anywhere.

My 80-year-old dad became quite ill due to Parkinson's disease and congestive heart failure. When his care became too much for my 81-year-old mom, she found an adult family home nearby, and he moved there. They monitored his many medications, helped him bathe and dress, and gave him breakfast and lunch. Then, after lunch, an Access bus picked him up and took him home to Mom, with his packet of afternoon medications in his pocket. He spent the afternoon in his own house, in his own chair, and with his little dog by his side.

After Mom's home-cooked dinner, the bus came to take him back to the adult family home, where they helped him get ready for bed and checked on him during the night. Except for Fridays (Mom's "day off"), Dad spent afternoons at home until the day he died at 84. He never felt that he'd been "sent away" or was a burden, and he had all the care he needed — and Mom's health wasn't compromised by being an exhausted caregiver. Most important: They still had the companionship they'd shared all those years. What smart folks they were to think this up.

A: Your parents were indeed very smart. Combining home care with the adult family home allowed them to stay together part of the day, your mom to get relief from the 24/7 of caregiving, and your dad to get the care he needed — a win-win all around. I appreciate your letting me share it with my readers.

Q: I'm confused about living wills and POLST (Physician Orders for Life Sustaining Treatment) forms — I read that my living will won't work when someone calls 911, and that I need a POLST form instead. I'm healthy and strong now, but I want to make sure my wishes for no heroic treatments are honored if something happens to me. What's the answer?

A: I understand your confusion, but there are important differences between living wills and the POLST form — and one other essential document, a Durable Power of Attorney (DPOA) for health care.

Every competent adult needs to have both a living will and a DPOA — yes, even people in their 20s and 30s. Living wills are for the tragic accidents that none of us can predict (and hope never happen) — but leave us so badly injured or ill that we can't express our preferences for treatment. They're also important for withdrawing treatment at the end of a terminal illness, when someone has slipped into a coma. They help our family and health-care providers make informed decisions about our care, says Allison Feher, legal director for King County's Senior Rights Assistance.

The reason a living will doesn't work when you call 911 is that emergency personnel can honor only a doctor's order, and a living will is not a doctor's order. Instead, their job is to stabilize you and rush you to a hospital, where a search is begun to find someone authorized to make decisions for you.

That's when your living will is needed, to guide your family in making treatment decisions (hint: Make sure your family and friends know where it is).

Unfortunately, living wills are not strong legal documents and are frequently ignored. What you need in addition is a DPOA for health care that names someone — your "proxy" or substitute decision-maker, such as a spouse, adult child or friend — to make health-care decisions when you can't, then to make sure your wishes are carried out.

POLST, on the other hand, stands for "Physician's Orders for Life-Sustaining Treatment," and is intended for people with a serious medical condition. To be valid, a physician must sign it, allowing you to tailor your care to your particular illness. In addition, the POLST form is portable, meaning it goes with you from nursing home to hospital to home. Because it's bright green, emergency personnel identify it immediately and follow its directions.

If you become incompetent before signing a POLST, the person you named as your proxy (or other authorized person) can sign it for you, thus assuring that, no matter how ill you are, your end-of-life wishes will be honored.

There's also a proactive way to use the POLST, says Robb Miller, executive director of Compassion & Choices of Washington, in Seattle. While you're healthy, you can fill out a POLST as though for a worst-case scenario, such as a major stroke or car accident, and ask your physician to sign it. Then put it away, making sure your health-care proxy and family know where it is. It won't become effective until it's presented, meaning life-support measures will be available to you until then.

"Please remind your readers," says Miller, "that they don't want to jump the gun. There are times when CPR and aggressive treatments are needed to get people back on their feet. Preventing treatment in those situations would be foolish." The purpose of these forms is to let you have a say when that's no longer an option.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist on aging and long-term care, she consults with individuals and teaches workshops on how to plan for one's aging — and aging parents. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.