by Phyllis Larkin, Psy.D
Geriatric and Family Psychologist
Last month we discussed ways to deal with a medical crisis from abroad. This month I will delve into the legal documents that should be established and/or reviewed to make caring from abroad easier on you and your loved one. This month we will focus on “Medical Grab Bag” documents. (Next month: financial documents.)
With an ill or aging loved one in your life, you will need a “Medical Grab Bag” that contains all the documents your loved one and their doctors will need to respond to medical needs and wishes for emergencies and end-of-life care. Each bag (or envelope) should have the completed documents. The Medical Grab Bags should be in the car, the home, and with loved ones when traveling.
Medical Grab Bag Documents:
- HIPAA Release forms for each doctor
- Medicare Card
- Supplemental Medicare Insurance Card
- Medication List with Provider and pharmacy contact information
- Durable Power of Attorney
- Living Will/Advanced Directive
You may feel overwhelmed at the list, however, your loved ones’ doctors are familiar with all these documents. We'll review a few of them here.
I suggest you let your loved one know you want to be their advocate in the case of accident, injury or illness, and that you need to know their wishes in order to advocate for them. By having this tough conversation, you can serve them as they have served you. (We have been discussing how to approach this topic in the Caring from Abroad Support Group. Come and join us!)
HIPAA Release Form (Medical information release)
The Health Insurance Portability and Accountability Act, also known as HIPAA, was created in 1996 by the U.S. Congress to protect the privacy of your health information. The act prohibits your health care providers from releasing your healthcare information unless you have provided them with a HIPAA release form. Unless you have provided a signed release form, health care providers are prohibited from discussing any aspect of your medical information with anyone who is not directly involved in your care. A HIPAA Release does not give you the authority to make medical decisions. You will need POLST, Medical Power of Attorney, or DNR.
A HIPAA Medical release form allows whomever on the release to talk to the physician. It’s wise to have a release form for each physician, insurance carrier, and financial obligations. The identified person will have full access to both medical and financial information so that they can speak and write to health care providers and billing personnel. This form does not give you power for medical decisions.
- General practitioner or gerontologist
- Any specialists involved in your loved one's care
- Insurance companies
- Hospitals/institutions/medical centers
- Assisted living
- Pharmacy (local and mail order)
What is a POLST form?
POLST stands for Physician Orders for Life-Sustaining Treatment. It’s a one-page form, usually on bright pink paper, that specifies the end-of-life treatments that someone does or doesn’t want. Copies are valid.
Why a POLST?
If your loved one stops breathing or their heart stops beating, EMTs and hospitals must follow the instructions on a POLST because it’s a medical order signed by a doctor. It’s legally recognized in many, but not all, U.S. states.
A POLST is usually recommended for terminally ill or very frail seniors who have made their end-of-life wishes clear.
Where to post your POLST?
A POLST is only honored if people know it exists. Make sure doctors, hospitals, and assisted living communities have the form on file and/or post it prominently in your senior’s room. Print copies on neon colored paper for your Medical Grab Bag and for family members.
At home, it is wise to have multiple copies:
- On the fridge and/or bedside table for EMTs
- Glove compartment Medical Grab Bag (Medicare cards, Medicare supplemental Cards, Physicians’ names and contact info, family contact info, Advance Directive, POLST, Living Will)
- All family members who may interact with medical personnel or EMTs
What is a DNR?
DNR stands for Do Not Resuscitate, and it is also a signed medical order written by a doctor. It tells health care providers and emergency medical personnel not to do CPR on your loved one if they stop breathing or if their heart stops beating.
The DNR is only a decision about CPR (cardiopulmonary resuscitation). It does not affect any other treatments, such as pain medicine, other medicines, or nutrition.
For doctor’s orders about other end-of-life treatments, your loved one may want a POLST instead.
POLST vs. DNR: The most important difference
The primary difference between POLST and DNR is that a POLST covers a variety of end-of-life treatments. A DNR only gives instructions about CPR. (DNR=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 EMTs or hospitals.
Why do seniors need a POLST or a DNR?
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 cannot stop these efforts without a signed medical order.
How to get a POLST or DNR
After talking with your loved one, discuss their end-of-life preferences with their doctor. The doctor should have access to the appropriate forms for your senior’s state and must sign the official form. They can also make sure the form is filled out accurately and completely so it won’t be rejected during an emergency.
It’s essential to use a form that’s legally recognized in your loved one’s state. No matter which forms are legally recognized, it’s important to discuss end-of-life preferences with their doctor. They can advise you on how to ensure those wishes will be carried out.
How a living will and POLST work together
To make sure your loved one's wishes will be honored in any situation, they should have both a living will and POLST. Keep them in your Medical Grab Bag so you can show them to doctors, hospital staff, and EMTs.
POLST vs. living will
|Age requirement||For any age||For age 18 and older|
|Who can use it?||Only those who are seriously ill or frail||Anyone regardless of current health|
|How is it used?||To direct immediate medical treatment||To direct future decisions about medical treatments|
|Tells EMTs & hospitals what medical treatments can be used in an emergency||YES||NO|
|Guides patient treatment when staying in a facility or hospital||YES||YES|
|Appoints someone to make health care decisions on your behalf||NO||YES|
Durable Power of Attorney for Healthcare
A medical power of attorney (also known as a health care power of attorney or durable power of attorney for health care) is a legal document that authorizes someone you trust (called an agent, attorney-in-fact, or surrogate) to make medical decisions on your behalf. The agent only has this authority if it is determined by your doctor that you are incapable of making such decisions, or you are unable to communicate your wishes, if you’re in a coma, for example. -Edward A. Haman, Esq., October 2015
An advanced directive expresses your wishes regarding medical treatment in very specific situations. It is more limited than a health care power of attorney. A living will does not appoint anyone to make decisions for you, and only applies if you are in a terminal condition, or in a permanent unconscious condition. A few states also permit a living will to be effective when “the burdens of treatment outweigh the expected benefits.” Therefore, if you are temporarily incapacitated but are expected to recover from an illness or injury, a living will does not come into play and does not allow someone to make treatment decisions for you. Only a medical power of attorney would help in this situation.
A living will and a medical power of attorney may be incorporated into a single document or can be separate documents. -Edward A. Haman, Esq., October 2015
How a living will or advanced directive works
A living will / advanced directive is a legal document that contains your loved one's end-of-life preferences. When decisions need to be made about future treatments, a living will guides the health care agent to make choices that honor their wishes.
Because a living will isn’t a medical order, it can’t tell EMTs and hospitals what to do. Even if resuscitation or other end-of-life choices are specified, they can’t be honored. Standard emergency medical protocols must be followed unless a doctor’s orders say otherwise.
Living wills are more useful in non-emergency situations like when someone is in a hospital or skilled nursing facility.
What’s the difference between a Durable Power of Attorney for Healthcare and an Advance Directive?
Here is a quick comparison between the Durable Power of Attorney for Health and the Advance Directive:
|Medical Power of Attorney||Advanced Directive|
|Must be created by an Attorney||Yes||No|
|Allows you to clearly state your health care wishes||No||Yes|
|Requires Notarized Signatures||Yes||No|
|Considered a Legal Document||Yes||Yes|