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When interviewing potential long term care facilities, admissions staff told me the health care proxy may be asked if they prefer to hospitalize or not hospitalize their parent. Is this the same as deciding hospice and palliative care? This is the first time I heard this decision must be made by the HCPs.

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SummerHope: This is in the same vein as DNR.
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Reply to Llamalover47
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I will add an experience I learned as my wife’s health declined. hospitals are not for the old or deteriorating. They are trauma centers and focus on immediate care. If you have a chronic condition or age related condition they can not and WILL not help. You are best to find a care home or inhome care. That is what I did.
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southiebella Jul 19, 2024
Well said.
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Practitioner orders for life, sustaining treatment (polst).
It gives you the choice of a DNR plus options of full treatment, selective treatment, or comfort focus treatment. It also includes the option of medically administered nutrition. My mother is at home with a 24/7 caregiver and I have hers on her refrigerator . I have copies to go with her in the event she needs to go to the hospital. Each state has their own form and you can find that online to print/ fill it out and have your physician sign.
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Reply to Kaysmile10
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POLST is a great idea because you are being clear about choices. Palliative Care is a great option to help with this type of clinical decision making because they can help anticipate situations and guide you in how much may need to be done. It’s chronic disease mgmt. Hospice is for end of life comfort and care. Think of the order this way. PC is ongoing maintenance advice as you or your LO manages a long term dx. A POLST answers those situational questions/concerns/ decisions and hospice is providing comfort when treatment options are done.
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Reply to Bodyphysics
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Not necessarily
A person can be treated in a facility.
With Hospice you actually have a Team from the Hospice agency that will come in and check your LO. Weekly a Nurse would come and check vitals and check for any problems and order medications. A CNA would come 2 times a week and give LO a bed bath or a shower or bath and the CNA would order supplies. (Briefs, gloves, ointments, bed pads soaps,...) ((The Hospice CNA would take over what the facility CNA was doing as far as bathing, there can not be a duplication of service))
With Hospice you are also asked if you want a POLST (or DNR) signed. It is not required but a good idea. Without a POLST or DNR the facility and or the Paramedics will do CPR. (POLST also gives option for IV's and Intubation neither one Hospice will do) CPR on an older, frail person probably will not have a good outcome. Good possibility of broken ribs, cracked sternum, maybe a punctured lung the recovery from all this is difficult.

Given the option I would opt for a POLST and no trips to the hospital. And if the person is Hospice Eligible I would get them on Hospice.
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Reply to Grandma1954
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OliveBalla Jun 29, 2024
Thank you for this great information. Please tell me what POLST is? All these acronyms have me pulling my hair out. Thanks in advance!
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When Mom enterd LTC this was not asked of me. I was the one that asked about criteria for sending to the hospital. I was told id a resident hit their head, immediate ER. If they fell and no one saw it, ER. If they fell and no head involved, then the resident was observed. If there were signs of pain or maybe a broken bone, then they were sent. In the 5 months Mom was in LTC she was not sent to ER. First 4 months in the AL, she went 4x. Why, because she said she was in pain after a fall. Of course she was in pain aren't you when you fall? I told them unless she hits her head, just observe her. If she still complains about pain later on, then take her to ER. It would be on me if found the fall was more serious.
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Reply to JoAnn29
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I think it's pretty much pro forma, the same as asking about whether the resident has a DNR.
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swmckeown76 Jun 29, 2024
It is. But no one has to have a DNR. It cannot be forced onto anyone, even a POA. I always wanted my late husband (who had frontotemporal degeneration) to receive the same extent of health care as I'd expect to receive for myself. He had several ER and hospital stays during his six years, four months as a private-pay nursing home resident. Their policy was generally to send residents to the closest hospital by ambulance, a community hospital, although our metro area has two much better academic medical centers. During one time in the ER at this community hospital, they told me he'd need to be admitted. I said I wanted him transferred to one of the academic medical centers and gave them #1 and #2 choices. The physician assistant assigned to my husband in the ER said I was making the right decision and he'd do the same if it were his mom or dad. That transfer cost *me* over $6,000 and was worth every cent. My husband left that academic medical center 10 days later and lived another 13 months.
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