As individuals retire or age into Medicare, their insurance situation can change dramatically. There are a multitude of options open to those with Medicare. The terms are different, the prices are different, the products offered are dramatically different each year.
The purpose of this column is to give those who are eligible for Medicare, or soon to be eligible for Medicare, some understanding of their insurance options and how it could impact their health and finances.
These questions and answers are meant as a guide to help you understand the complex questions you are now thinking about. Each individual's specific situation may create a different solution. You shouldn't necessarily do what your friends, family and neighbors do.
Q: I have a Health Care Proxy; I did one after your recent article. Then I heard about a "MOLST." What is a "MOLST," and do I need one?
A: I am always thrilled to hear someone say they already have a health care proxy completed. You have taken a big step toward protecting your wishes.
Today you asked about a MOLST, which is an acronym for Medical Orders for Life Sustaining Treatment (MOLST).
This type of advance directive is a legally binding document that applies across all health care settings in New York state. A MOLST form is advisable for people who are seriously ill, who might be in the last year of their life or have particularly strong health care wishes. This is a four-page, bright-pink document that includes medical orders from your physician and the other advanced directives.
The MOLST document includes a number of items. It is a medical order form that communicates your wishes regarding your medical care. These orders include the wishes that you and your physician have reviewed, and will continue to review over the course of your diagnosis and illness. This form is designed to carry those orders (your wishes) across institutional and facilities lines. The MOLST includes resuscitation instructions, DNR wishes, wishes regarding re-hospitalizations, comfort measures, limitations on medical interventions, intubation, ventilation, BIPAP, CPAP, artificial administered fluid and nutrition (feeding tubes and IVs), antibiotics and lastly "other instructions." This is a pretty extensive list. It is also a pretty extensive discussion to have with your medical providers so that you understand each one of these decisions.
This MOLST document is signed and renewed by your attending physician regularly. This MOLST form is a set of orders and directives that are transferable from facility to facility and setting to setting. You should attach a copy of your health care proxy and your living will to this MOLST document to make it complete. This type of document is ideal for an individual who is frequently hospitalized, or in a skilled nursing facility (SNF). The MOLST may not be necessary for everyone.
Once a MOLST document is completed, it is designed to be reviewed regularly with your attending physician. The individual themselves does sign the document once; their physician signs it multiple times. Once completed, the MOLST must be reviewed and renewed by a physician. How often this required review takes places depends on the setting; a hospital requires every seven days; a SNF/nursing home requires every 60 days and the community requires every 90 days.
This MOLST form was designed to be quickly readable and recognizable so it is hot pink in color. It is very easy to find this document in the multitude of paper generated by the health care industry. The individual always keeps their own original MOLST document. A physician can keep a copy of it. If in a facility (like a nursing home or assisted living facility) the original is kept in the individual's medical record.
Once this document is completed, I would recommend giving a copy of all these completed forms to your family and medical practitioners. You can't expect that individuals and physicians make good decisions on your behalf, if you don't inform them of what you want done.
A MOLST is not a document that everyone needs. If you are healthy, independent and able to communicate your wishes a MOLST is not necessary. A MOLST form is designed for those individuals that are in and out of different medical settings regularly. When I say "medical settings," I mean hospitals, nursing homes, emergency rooms and ambulances. In each of those settings there may be different standards for care and procedures. The MOLST document allows your wishes to be honored in each of those settings.
I have said that everyone 18 or older should have at least a health care proxy (HCP) completed. This allows for medical decisions to be made if you cannot communicate. If you are unconscious, in a coma or during surgery, a HCP allows for the person(s) you designate to make decisions guided by information you have communicated to them. It puts the decision-making power of your health care in your hands.
We never know when an accident or medical emergency will take place. This small amount of pre-planning and communication allows you to be in charge, whether you can actually speak or not. A MOLST does this, but so much more for the individual who has a very complex and ongoing medical situation, requiring regular or frequent transfers between facilities.
Much like other advanced directives, a MOLST is of little value if it is tucked away in a file cabinet. The emergency medical staff must see the actual document or they will not know your wishes. They cannot take your family or caregiver's word. So if you have a MOLST be sure to place it somewhere visible and tell everyone about its existence. Many people keep this on their refrigerator.
Janell Sluga is a geriatric care manager certified and works for Senior Life Matters, a program of Lutheran Senior Housing, and has worked in Chautauqua County with seniors for more than 18 years. She is HIICAP (Health Insurance Information, Counseling & Assistance Program) counselor-trained by Office for the Aging. She does not sell insurance or represent any insurance company. She is an unbiased source of insurance and education to help seniors choose the best option for them.