My Care, My Plan and the 2014 POLST

Timothy Gieseke, MD, CMD 

In Sonoma County, we have an organization called Sonoma Health Action (http://www.sonomahealthaction.org), which has gathered leaders across the business and health community to develop and support initiatives that improve the health of our residents.  One of our initiatives has been to promote advance care planning and improve access to palliative care by direct education of at risk members of our community.  The initiative is well titled “My Care, My Plan – Speak Up Sonoma County”.

Under this mantra, I introduced the newly revised POLST to residents of Spring Lake Village, which is a Continuing Care Retirement Community (CCRC) where I have been the Medical Director since 1986.  To overcome the awkwardness of advance care planning discussions, I attempted to “normalize” the discussion using Robert Frost’s poem “The Road Not Taken.  In life, there are times when we select a path with future implications.  Paths like college majors, careers, marriage, family, religion etc. have an exclusivity in the sense that once one enters a path, most of the subsequent choices are consistent with that particular path and not another.  In palliative care, our job is to help patients find the health care path that’s best for them.  I included in that presentation 2 helpful resources.  The first was the “SNF POLST cover sheet” from www.CoalitionCCC.org and the second was an excellent personal reflection tool, the “Values Checklist and Guide: My Choices near the End of Life (Susan Keller of www.CaringCommunity.org)

Since that presentation, I have used this pathway concept for having the conversations that help patients develop their “Care Plan” expressed in their POLST choices.  This has greatly increased patient acceptance of these conversations and allowed the conversation to proceed more naturally, just as it would if we were discussing prior life choices noted above.  Since that presentation, my challenge to our residents to take charge of their health has resulted in a number of clinic encounters where residents initiate advance health care planning discussions and then complete the POLST.

This success with POLST completions is only part of our mission to improve access to palliative care.  The other part exposed by the POLST is the lack of Advance Health Care Directives (AHCD).  In my experience, less than 15% of my short stay SNF admissions have an AHCD.  Whereas the POLST is designed for people in the last years of their life, the AHCD is an important tool for anyone over the age of 18.  With this tool, we can know who will best represent our patients and have a better idea of their preferences and values, should they be unable to express them in an emergency.

As we complete the 2014 POLST on our patients, remember to encourage completion of AHCD’s.  While this requires the presence of an ombudsman in the SNF setting, this is a great time for reflection and ensuring that our patients develop a plan for a better future. 

Hoping with you for healthier communities!

Attachment:

Values Checklist and Guide