MOLST – Getting Your End-of-Life Wishes into Your Doctor’s Orders

May 28, 2013

Filed under: Medical Care — Tags: — Alexis @ 10:00 AM

Massachusetts has recently enacted the MOLST program – that’s Medical Orders on Life-Sustaining Treatment. This is a solution to a question that a lot of clients ask: “How do I make sure my kids do what I want with end-of-life care?” Or more typically, clients say, “I want a living will.”

MOLST is better than a living will, and it goes further than a health care proxy. Until MOLST, you might share with your children what kind of treatments and care you do and don’t want as you approach the end of your life, and you might get a chance to talk about it with your doctor, and then you hope for the best as you gradually come to rely on others to make decisions for you.

With MOLST, you have a conversation with your doctor while you are able, and then – this is the key – the doctor turns those into “doctor’s orders.” The MOLST form is a pink sheet of paper, and once that is in your medical record, it’s going to carry a lot of weight.

With MOLST, you get to think about and talk to your doctor about the things that are already on your mind – would you want CPR? Ventilation and intubation? Dialysis? Artificial nutrition and hydration? And then you turn them into medical orders. That means that there is a pretty good chance (though no system is foolproof) that as you decline, your medical providers and family will not only know your wishes, but will honor them. Having them in your record as doctor’s orders makes all the difference.

What about changing your mind? Yes, you can. At any time, you can talk to your medical staff about changing a prior decision in the MOLST.

Family members may ask what to do if a parent or loved one is already at the point where they can’t discuss end-of-life care options themselves with their doctor – the MOLST process permits a health care proxy or guardian to review end-of-life choices with the doctor as well.

For more information, and to see a sample form, see the MOLST site. It’s a well written, easy to read site.

Please note that the MOLST process is meant for people with advanced illness or injuries. If you are healthier, then the best vehicle for sharing your end-of-life wishes is something like the Your Way workbook.

Howard Gleckman’s Caring for Our Parents

October 23, 2009

I’ve been reading Howard Gleckman’s book, Caring for Our Parents, in which he examines the long-term care system of today and the future. Essentially, if we keep on doing things as we are now (expect people to use up their savings to stay at home or in assisted living, have Medicaid pay for nursing home – with a few other public programs thrown in here and there), then the elderly of the next few decades are in for quite a shock.

My conclusions are these:

1. Write a Health Care Proxy and a Medical Directive, or Living Will My version of this is to give clients Your Way, a fantastic workbook that helps you spell out to your family what care you would want in various end of life situations. Long-term care is astonishingly expensive, as you know if you are currently coordinating at-home care or other support for your parents. If you don’t want that kind of money spent on you – if you don’t want certain procedures done or decisions made – tell your family now. During an emotional crisis, it will be very difficult for them to turn down a medical option without you having previously given them that moral permission.

2. Get thee to a financial advisor. The current long-term care system depends in large part on the consumer paying her own way. The Boomers are notorious for not saving money. Work with an advisor to see what kind of cushion you can build up.

3. Get involved in politics at the grass-roots level. As currently structured, the Social Security, Medicare, Medicaid, and long-term care insurance systems are projected to crash in on themselves. Additionally, Boomers don’t have the numbers of children that their parents do to share the workload. Your parents will be OK – an elder law attorney can help them stretch out their assets to stay at home for as long as possible. But the Boomers will not be OK. The system needs to be overhauled, dramatically. I don’t have answers, but Gleckman outlines the models that some other countries use. I’m sure there are other brilliant policy makers in the US coming up with excellent ideas, as well. But ideas become law only if the Boomers use their sheer numbers to push the system to provide the care they expect. Without big change, the Boomers will be in for quite the surprise in their frail old age.

Howard Gleckman’s New Book: Caring for Our Parents

August 25, 2009

Filed under: Estate Planning — Tags: , , , , — Alexis @ 5:27 PM

Driving to work on Friday, I had the treat of listening to NPR’s Robin Young interview Howard Gleckman on his new book, Caring for Our Parents: Inspiring Stories of Families Seeking New Solutions to America’s Most Urgent Health Crisis. I only caught the end of the interview, but it was so reassuring to hear him close with this message: we should all have our health care proxies and end of life wishes in order.

This is what I talk about when I give presentations and when I meet with clients. I’ve blogged about it – read about health care proxies here and about end of life wishes here.  This is such an important message to get across to people. A health care proxy lets someone else make health care decisions for you when you cannot make or communicate them yourself – anesthetic fog? dementia? shock from an accident? Without a health care proxy in place, your family could very well be forced to go to court and waste a lot of money, time, and emotion.

And making your end of life wishes clear will save your family a tremendous amount of anxiety, guilt, grief, and arguments. Give your family the gift of peace by taking the burden off of their collective shoulders – tell them ahead of time what you would want in a difficult situation.

It gives me hope to hear Mr. Gleckman advising a national audience to get their health care proxies and end of life statements in order. So many families would have such an easier time caring for their loved ones with these documents in place.

End of Life Wishes & Living Wills

Clients are always asking about living wills. Massachusetts law does not recognize a living will, and it’s also impossible to write a thorough, well balanced statement of your end of life wishes in just a few paragraphs.

I provide clients with a solution to their goal, but in a much better form. I give my clients a workbook called Your Way. It is published by a nonprofit in California, H.E.L.P.: Helping People Meet Aging-Related Legal & Care Challenges.

This workbook is twelve pages long and very thoughtfully walks the reader through various scenarios you could confront in an end of life situation and what kind of comfort and care you would like to receive. For example, what matters to you the most – being with friends and family? Listening to music? Being able to help dress yourself? Under various scenarios, would you want curative care or to be kept comfortable? Who do you want with you as you are dying? Where would you want to be? A twelve-page work book written by heath care professionals does a much better job elucidating your wishes than an attorney can do in a one-page living will.

If you are not a client of this office, then log onto the Your Way website and order a workbook. If you are my client, then you already have a copy. Complete the exercises and give your family the gift of knowing exactly what you would want them to do in a crisis situation.

Do You Have a Defibrillator or a Pacemaker?

February 25, 2009

Filed under: Medical Care — Tags: , , , — Alexis @ 11:27 AM

If you have, or if your loved one has, an ICD (implantable cardioverter defibrillator) or Pacemaker, you know what amazing devices these can be for saving lives.  But if you are in and end of life situation and have made the decision to cease treatments and to focus instead on palliative and comfort care, please remember to have these devices turned off.  

With some frequency, patients sign a Do Not Resuscitate form and maybe even enter hospice treatment, but no one thinks about the ICD or Pacemaker.  Leaving them on can make the dying process very painful for the patient and emotionally wrenching for the family.  Apparently, the patient’s body lurches over and over again and it feels to the person as if horses are kicking in her chest.  Far from the peaceful goodbye that we all hope for.  

So please, if you have one of these devices and have chosen to execute a DNR or to enter hospice care, talk to your medical team about turning it off.