By: Jeanne M. Ryan, MA, OTR, MBA, CHCE
Executive Director VNA & Hospice of Cooley Dickinson
According to the Massachusetts Expert Panel on End-of-Life Care:
“What people want and need as the end of life approaches are things that have mattered to them throughout life, often now more intensely then ever: that their wishes and values are respected, that their symptoms are well controlled; that their dignity is maintained; and that they can spend as much meaningful time as possible with those they most love”.
And while 70 percent of Americans say they wish to die at home, surrounded by family, in Massachusetts the reality is exactly reversed: More than 70 percent die in hospitals or nursing homes, often spending their last days or weeks attached to high-tech life support machines. The choices that patients and their families make about care at this stage of life are extremely personal, but can only be made well if the full range of options is presented, explored, and considered with each patient individually.
For some, end-of-life care will include the use of advanced medical technology that attempts to extend life even if the burdens of treatment increase and the odds of success diminish. Others will prefer, as their illness advances, that their care prioritize comfort and time with family in their own homes. In order to insure that Massachusetts residents understand the full range of choices available to them, and to ensure that health care decisions in the face of serious illness are anchored in each individual’s goals and values, we must not only engage in serious conversations about our end-of-life care wishes with family, loved ones and healthcare providers; we must ensure that these wishes are well documented.
One approach designed to insure that end-of-life wishes are appropriately documented and implemented is known as the MOLST (Medical Orders for Life Sustaining Treatment). A completed MOLST form, signed by the patient (or surrogate) and the patient’s healthcare provider, is a transferrable medical order that is designed to insure that the preferences of patients with serious advancing illness are respected across care settings. The Massachusetts Legislature has already initiated a pilot MOLST program in the Commonwealth and expects full statewide adoption of the MOLST form by all healthcare institutions by January 1, 2014.
In order to insure that community members, hospital staff, and local physicians were knowledgeable about the use of the MOLST, the VNA & Hospice of Cooley Dickinson took the lead in conducting training and education sessions to all of these stakeholders. Once such training exercise included the making of a 20-minute MOLST Video which portrayed a physician, a patient, and the patient’s healthcare proxy, discussing the patient’s end-of-life wishes while completing the MOLST form. This video has been shown in public forums and also distributed to physicians for viewing.
Accordingly, Cooley Dickinson Hospital modified its policies and trained its staff to ask their patients if they would like to complete a MOLST form prior to discharge. Volunteers interested in improving end-of-life care also presented information on the MOLST at local senior centers, libraries, and town halls to ensure that community members knew this form was available to them. All patients cared for by the VNAH staff are asked about their end of life care planning and the MOLST form is reviewed for completion with the patient’s healthcare provider.
While most of us would rather not talk about the end of our lives, it is vitally important that we not only begin talking about our end-of-life wishes, but that we document these wishes in a way that ensures these wishes will be carried out. Completing the MOLST form is one way to insure this happens. Home health agencies should not underestimate the important role they can play in this process!
Patient-Centered Care and Human Mortality. The Urgency of Health Systems Reform to Ensure Respect for Patients’ Wishes and Accountability for Excellence in Care: Report and Recommendations of the Massachusetts Expert Panel on End-of-Life Care. October, 2010