It appears that the government DNR medical directives has not been successful. To put teeth in the end of life medical directives and cut out all medial services for seniors who are chronically ill, the government has devised new end of life orders called “POLST” (physician order life sustaining treatment). This will limit medical costs to around $27,000 during the last 6 to 12 months of the life of our seniors. This agreement is now legalized and in effect in over 30 states.
This signed agreement will be placed on electronic medical records available throughout the nation, and once signed, will limit services to minimal end-of-life care. It gives teeth to the advance medical directives, which are often not available on hospital admission, often are not located, and certainly not disseminated around the country.
With this new contract, EMS will quickly know who should not receive their services. Hospitals will know that they are legally bound to limit care to a chronically ill senior. The emergency medical records will be in a national database and available for all health providers to see immediately.
ADVANTAGES OF THE NEW POLST ( physician orders life sustaing treatment)
Numerous frequent hospital admissions will be cut out if you have the same diagnosis and have had two or more admissions in the last year.
This end-of-life care will free “critical care beds” in your final days.
Heart and lung patients are living much too long.
If you are frail, and your doctor anticipates your death in the next 12 months, you have many risks or complications, and might lose your decision-making capacity, it will be taken away from you once you sign for “POLST”. This will eliminate costly life-sustaining treatments.
Michigan judge Milton Mack, 9.9.2010–450 Michigan 204 ( 1995).Ruled: a Guardian cannot sign a DNR if you are in a nursing home and are not terminally ill or two he never expressed an end-of-life wish.
The facilitator in POLST, is skillfully trained to become passionate and successful, establishing a loving relationship that allows him to win power authority over you. A facilitator starts a conversation, and claims to assist you in making a plan that will take precedence over your decisions. He is well trained, skillful, and has a mission to have you sign any “POLST”( physician order for life-sustaining support)..
He makes you feel that your steady decline is predictable. There is great emphasis on freeing you from pain and suffering, and eliminate it from a park of dying.( There will be no way of the cross before your crucifixion). This will allow you to be treated as a whole person, and her spiritual, cultural, the ledges, and social needs will be met as you die. Your illness is a personal experience”, not just unsolved medical problems. This allows your life to be not put on hold by terminal treatments, and gives you relief for your pain and other symptoms.
The facilitator begins by saying: “I just want to know what is important to you as you make here healthcare decisions. Let me help you make good future choices. Don’t be afraid, there are solutions for everything. But mainly due papers that will tell your doctors Everything that you specifically want.
Long-term chronic issues require knowledge about the outcome of all your treatments. I know you don’t want to be a burden nor die like your mother died. You deserve to die with dignity and have to think about these things. You deserve a good quality of life! If you want to think this over with your family, before you make this decision it’s perfectly okay. Here are some brochures explaining here possible treatment choices.
You look confused and have a lot on your mind. I know you have questions about your disease and your treatment complications. I will have your specialists come and he will address these concerns. As you sign this page, please name the person who will carry out your decisions if you can’t make them for yourself
Let’s call that person “advocate”, so he will know exactly what you want. Oh remember, you can always dare this paper up any time, and start over ( By canceling an automatic magazine subscription).We also have letters for your new DNR, advocate directives, and the polls to, so you’ll should sign them all “
Trust me! I want to honor your informed decision. I am in this paper giving specific instructions dear to your state of “health”. Your doctor will be forced to honor the medical orders we are drafting now. This eliminates the “it’s” and “buts” of your chronic illness.”
You have now eliminated the last six months of your medical care. You will not need to be going frequently to ICUs, nor make frequent visits to doctors. You will get an earlier referral to a hospice, not allowed to be overtreated, and lower the cost of unwarranted medical care. You are solely and gently nudge to make a decision in the best interest of economy.
Medicare now requires that you receive written information about your rights to accept or refuse treatment and to prepare you for advance directives. You are told about the goals of treatment, your chances of achieving the goal. The possible side effects aren’t told to you, nor the burden you create on your family as you seek your goals. Intensivists at the hospital are ready to expedite the end of your life. You are shifted from concentrating on your illness, and told to focus only about life completion as a goal.
You’re told medical treatments no longer will be beneficial. You will not be given these worthless treatments as an option, but allow to focus only on why it will not be pursued or attempted. You our tool to focus on the last months, how you are declining on a slippery slope, and consider the fact that you have had enough and would like to end the life soon.
Rather than prolonging life, you are told you are making it only longer to die. By accepting “ Palliative Care”, you will eliminate active treatments that likely will not work, and shorten the length of your dying. Family conflict will be eliminated as you are now addressing these distressing symptoms you have. This is an opportunity to complete your life and be active in managing your dying, and providing bereavement, and helping their memorial plan ( perhaps a donation to our continuing hospital program). We now can provide you mental health, as well as spiritual support and relieve you of the great burden you have. We are going to let you die “naturally” without fear of resuscitation.
THE DETAILS OF YOUR POLST CONTRACT
How do the health providers know when they should activate your signed government POLST agreement?
The agreement will be enforced if your functional status has declined in the last 60 days, you had more than one hospitalization in the last week, your pain level is getting to you, you now have trouble walking and have some dementia (confusion),you have metastatic cance, or have “ advanced” heart disease.
You are ineligible for an ICU bed if you came from a nursing home, have one or more life limiting condition, been in the ICU twice, had prolonged ventilator withdrawal, or have multiple organ failure.
Your POLST contract eligibility is extended to if you have cancer that is locally advanced, despite treatment, have a brain metastasis after radiation, develop spinal cord compression, have progressive food around your heart, your chemo has failed twice, or you have painful bone metastases.
You will be refused f emergency room coverage if you come from a long-term care facility, have had recent multiple hospitalizations with some problems, have come from a hospice program, your caretaker thinks you’re getting worse but you have had no referral, you personally think you need ICU or some mechanical ventilation, you have moderate confusion ( a cognitive defect in dementia), or have some chronic disease which you cannot control.
The following criteria are used to label you “chronically” ill patient. If you have decreased ability to function at home, have had more than two recent hospitalizations, your care goal is uncertain, your family wants to try out terror, there is a DNR order conflict, you need t tube feeding, you are seriously ill, you are cognitively impaired, you are homeless and have some chronic mental illness, you are spiritually disturbed, or your family is asking for hospice information.
You are eligible for hospice if your condition is likely to kill you in six months, if two licensed doctors say you need it, or a competent caregiver says you need hospice,
The sales pitch you will hear is: Let’s talk about dying and what you will experience And expect as things change. We certainly want to exclude from your mind anything that you do not expect. Your pain and breathing will be totally controlled. You will not go crazy or lose your mind. Medicines given to you will make you calm and comfortable, and you will sleep most of the time. Are you okay with that?
You will start having less energy and will be resting most of the day. Within usually about three weeks, your body symptoms will shut down, and while you are sleepy, your heart will stop. I repeat we will never let you have any pain or breathing crises.
You deserve this care so that you can stop your illness. You certainly shouldn’t die without the scare. Hospice will relieve your burden on the family and you will get “coordinated care”. A doctor will visit you, and a nurse will be accessible for 24 hours a day. While you are at the hospice, we will help you secure a chilly and help you plan your memorial and even your bereavement.
Over 25% of Medicare money is spent on end-of-life care. One out of eight medical dollars are spent during the last month of life. Most of it is because of high tech interventions and “rescue” therapies. 25% of Medicare dollars are spent on only 5% of the beneficiaries who died during a given year.
POLST will eliminate end-of-life treatment, and lower our total US healthcare costs by over 12%. You can now see why this ploy is important to balance the government’s debt. Your cooperation is anticipated.
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