Peter C. Sisson, CELA, Certified Elder Law Attorney
President Board of Directors, Idaho Quality of Life Coalition
On July 1, 2007, Idaho’s governor signed into law a revision to the Medicaid Consent and Natural Death Act (Idaho Code §§ 39-4501 et seq.). This change created a standardized form that allows all Idaho citizens over age 18 to express their wishes regarding how they want to be treated from a medical perspective. This form is called the Physician Orders for Scope of Treatment, or POST. The POST is a doctor’s order and must be signed by your doctor in order to be effective. It replaces the former Idaho Do Not Resuscitate (DNR) and Comfort One programs.
What is a POST?
The Physician Orders for Scope of Treatment (POST) is an extremely important tool with a number of unique features designed to help make sure your wishes are honored if you can no longer speak for yourself to make health care decisions. If you are facing serious illness or would like a POST for other reasons, click on the link to open a sample copy of the Idaho POST. Then, simply print it and take it to your healthcare provider and ask them to complete an actual POST with your input.
The POST is a one-page document designed to help health care professionals (doctors, nurses, emergency medical services, long-term care/nursing home staff) and family members understand a person’s goals for care and to honor the treatment wishes of that person. The POST form is a short summary of treatment preferences and a physician’s order for care that is easy to read in an emergency situation. The POST form is not intended to replace an advance directive document (living will or durable power of attorney for health care) or other physician orders.
The POST does replace the former Comfort One/DNR as Idaho’s recognized Do Not Resuscitate order. While a Comfort One/DNR form that was completed prior to July 1, 2007, is still valid (as are some DNR orders from other states), it is recommended that a POST be created to replace any other forms of DNR orders.
Is the POST valid in all settings?
The POST form accompanies the individual at all times and is “portable” across care settings. This means that the POST form is effective in the home, in EMS (Emergency Medical Services) settings, in the hospital, in a residential care facility such as a nursing home or assisted living facility, while receiving hospice care, or in any other place that the individual is residing.
Who should have a POST?
Cardiopulmonary resuscitation (CPR) is a major element of the POST form and is found at the top of the POST form. It is your choice as to whether CPR is right for you. This depends on your age and health care status. Your physician will give you information to help you make your decision. That is why the POST form is filled out with advice of your physician.
You need to have a POST if:
How do I obtain a POST form?
The POST form is obtained by your healthcare provider. In order to be valid, a POST must be signed by both the individual (and/or the individual’s agent acting under a durable power of attorney for health care) and his or her physician/physician assistant/nurse practitioner. Because the POST is still new in Idaho, not all providers may be familiar with the program. It may be useful to bring a copy of POST FAQ for Patients and POST form: FAQ for Providers with you when you plan to discuss creating a POST with your physician.
The POST provides the opportunity to detail the specific directives from other advance care planning tools (durable power of attorney for health care and a living will) on a standardized form. When signed by a physician, this document translates an individual’s preferences for life-sustaining treatment into medical orders.
What if I do not have a POST form?
If you do not have a completed POST form and someone calls 911 in an emergency situation, you will be revived with CPR by Emergency Medical Services (EMS) personnel. Emergency personnel are required by law to perform CPR unless a POST tells them not to.
How will EMS know I have a POST?
What about my living will and durable power of attorney for health care?
Use of the POST form is expected to complement your advance directive (living will and durable power of attorney for health care). If you do not have an advance directive in place, please go to Appendix B of RCRT and make a copy of the living will and durable power of attorney for health care form that you can fill out and sign. Make sure you understand this form before you fill it out and sign it. It is best to seek the advice of a health care provider or other professional when filling out this form. Your physician, clergy/spiritual leader, or a social worker at the local hospital may be available to help you with this task. Family input is important.
In states where the POST (also known as “POLST: Physician Orders for Life-Sustaining Treatment) has been adopted, there is a higher user rate for advance directives and people’s wishes are followed more often. The POST has been shown to reduce unnecessary hospitalizations and improve end-of-life care planning.
Register your Advance Directives and your POST.
You may register your advance directives (living will and durable power of attorney for health care) and/or your POST in the Idaho Health Care Directive Registry (see Section 6, RCRT). This confidential, secure registry is located within the Idaho Secretary of State’s Office and is available at no cost.
The advantage of registering your documents is that all health care providers with Internet access may view these documents through a secure database in an emergency. The health care provider will be able to understand your health care wishes and also obtain contact information for the important people who may need to make health care decisions for you.
Your physician will discuss care options with you and help you complete a POST form. In order for a POST to be valid it must be signed by a physician.
The Idaho POST is a universally recognized document that provides an opportunity for individuals 18 years or older to state their wishes for health care. Valid only when signed by a physician, this one-page document is a Physician Orders for Scope of Treatment and informs emergency medical services and health care personnel of your wishes for cardiopulmonary resuscitation (CPR) and other important treatment options. The POST complements your advance directives (living will and durable power of attorney for health care) and increases the likelihood that your wishes will be respected.