Katherine Herczeg, MSN, APRN
Bitterroot Physicians Clinic South
3334 Dvn Lane, Darby MT 59829
Caregivers and Executors Matter: Dignified Aging Part II
In Part I of this series, we discussed the impact of aging and the importance
of preparation and education of your loved ones in regard to your healthcare
plans. Important terms we defined at that time included: advance directive,
caregiver, and executor. At this time, I would like to build on those
terms and provide you with information on how to get these documents organized
When it comes to making informed decisions about end-of- life care and
services remember the acronym, L.I.V.E. Learn about options for end-of-
life services and care. This conversation can be initiated with your health
care provider, an attorney or even by contacting local services such as,
Council on Aging (contact information will be provided). Implement plans
to ensure wishes are honored. This may include a varying combination of
the following actions: create an advance directive, appoint a medical
power of attorney or have a POLST form created with your health care provider.
Voice decisions to family, friends and health care providers. End-of-
life care is very personal and you may share different views than your
loved ones. Having your wishes written make it easier to follow. Engage
in personal or community efforts to improve end-of- life care. Ask questions,
lots of questions. I will include ones that are imperative to ask in an
effort to guide you.
Please be aware that there is a difference between a POLST (Physician
orders for life-sustaining treatment) and an advance directive. A POLST
form does not replace and advance directive but they work together. While
all adults should have an advance directive, not all should have a POLST.
Both of these documents are considered advance care plans and provide
information about treatment wishes but they give different information.
A POLST form is a medical order for the specific medical treatments you
want during a medical emergency. Only individuals with a serious illness
or advanced frailty near the end-of- life should have this form. An advance
directive is a legal document used to provide guidance about what types
of treatments you may want to receive in case of a future, unknown medical
emergency. It also is where you say who can speak for you to make medical
treatment decisions when you cannot speak for yourself (medical power
of attorney or "surrogate").
A POLST Paradigm Form gives medical orders to emergency health care professionals
to follow. Since the POLST Form is completed only when someone is seriously
ill or frail, their diagnosis and prognosis is known and so more specific
treatment decisions can be chosen and documented on a POLST Form. An advance
directive is a legal document, not a medical order, and does not provide
treatment orders. Instead, it lets health care professionals know generally
what types of treatment the patient may or may not want during some unknown
medical crisis. Since a POLST Form is a medical order, EMS/EMTs can follow
the orders during an emergency. If you only have an advance directive,
EMS/EMTs must do everything possible to attempt to save your life. Once
you are stable, then health care professionals will review your advance
directive with the person you named as your surrogate, and decide on a
treatment plan based on the guidance you provided in your advance directive.
The POLST may be initiated with your physician or health care provider.
Montana's End-of-Life Registry stores advance health care directives
in a secure computer database and makes these documents available to health
care providers. The Registry does not provide legal advice or legal services.
Consumers should consult with their health care provider, attorney or
agencies that specialize in end-of- life care choices about any questions
they have related to advance health care directives, living wills, health
care (medical) powers of attorney and other personalized directives. Further
information can be found online at:
- Aging with Dignity's Five Wishes directive
- American Bar Association (ABA) Commission on Law and Aging and Tool Kit
for Health Care Advance Planning
- Caring Connections
- MHA: An Association of Montana Health Care Providers
- Mayo Clinic and Living wills and advance directives: Tools for medical wishes
- Montana POLST (Provider Order For Life Sustaining Treatment)
Once created, both your advance directive and/or POLST need to also be
kept in a visible area such as near your phone or on your refrigerator
as well as on the end-of- life registry if you so choose. Your health
care providers and most used medical facility will need a copy which becomes
part of your permanent medical record. Please don't forget that you
can always change your mind about the treatment plan or "surrogate"
that you mention in these documents and are encouraged to update and change
these documents as you encounter new life events.
I hope that the above clarifies a topic that can be elusive and confusing.
Don't forget that the conversations have to start somewhere. Consider
contacting the Council on Aging which is located in your very own, Hamilton,
Montana. This is a resource center for persons in Ravalli County 60 years
of age or older or those qualifying with a disability. They can be reached
at: (406) 363-5690 or
In closing, I hope I have imparted on you the importance of planning during
the aging process and look forward to continuing this discussion on Thursday,
December 8 th at Caregivers and Executors Matters class at Marcus Daly
Memorial Hospital from 5:30pm to 7pm. Larry Johnson, Attorney at Law and
I are hosting this class and looking forward to sharing more about being
prepared for end-of- life and answering your questions.
For questions and or comments see you at the health class and or contact
Katherine Herczeg, MSN, APRN at Bitterroot Physicians Clinic South, a
clinic of Marcus Daly Memorial Hospital, at 3334 Dvn Lane, Darby MT 59829
or call (406) 375-4142. Working together to build a healthier community!