MOLST—crucial conversations needed for seniors

Senior communities and health care providers often find themselves managing difficult choices for the frail and terminally ill. End of life conversations are often fraught with anxiety for both seniors and those who care for them.

Yet these crucial conversations help us to understand seniors’ perspective, values and choices, so that we can together translate them into specific healthcare actions. In fact, these discussions are a critical component of providing good quality care for older people like those whom we love and serve at United Church Homes, a national network of 67 affordable housing, residential and health care communities based in Marion, Ohio, including the Glenwood Retirement Community and Harmar Place skilled nursing facility in Marietta.

Sometimes broaching these topics feels like pointing out the “elephant in the room.” While advance health care decisions can be very hard to acknowledge, for many there is a sense of relief at having the conversation started and preferences confirmed out in the open. Too often, the discussion never occurs at all until the moment of crisis is close at hand. I have witnessed too many families forced into making important decisions for their aged loved ones in the middle of a healthcare crisis. Or worse yet, unable to make decisions without proper legal authority or a clear sense of what their loved one would have wanted.

We can do better. We-families, caregivers, and health care professionals – can guide older adults with love, patience and candor through these difficult conversations. In doing so we can help them clarify the core values and beliefs that are preserved for the moment when others must decide. Ultimately this enables caregivers to assure their elders better care coordination among the different professionals for the delivery of services as they approach the end of their life.

The Ohio Senate recently passed legislation which will do just that. SB 165 will reform Ohio’s current do-not-resuscitate form (DNR) and replace it with a more effective tool known as Medical Orders for Life-Sustaining Treatment (MOLST). The Ohio House is expected to consider this later in the year.

MOLST is voluntary, and is only designed for patients with advanced illness, or who are frail or elderly-those for whom these conversations are most important. Unlike the DNR, MOLST will encourage communication about end of life decisions, provide more clarity to patients, and their families and care providers. It will facilitate thoughtful reflection for patients and their families, physicians, and spiritual and religious guides.

MOLST has been enacted in 22 states, and these states found that patients with a MOLST form are more likely to die in the setting of their choice. This means that individuals who have made their home at Glenwood and Harmar Place will not have to be sent to the hospital as they near the end of their lives. This means that the families that live in our residential living, assisted living, memory care and skilled nursing do not have to worry that emergency responders will insist on transporting them via ambulance to an emergency room. This means less fear and worry for the seriously ill individuals we care for, and more time for the important things: family, loved ones, or whatever else is most important to that individual.

United Church Homes, along with Glenwood Community and Harmar Place, are proud to be among hundreds of organizations represented in a statewide coalition of healthcare providers, patient advocates, and religious organizations working hard to make MOLST a reality for the individuals we care for. Together with bill sponsors, legislators and stakeholders, this coalition has carefully designed SB165 with special protections in place to prevent it from being abused or even used as a vehicle for physician assisted suicide. Together, we are certain we can improve the way we care for the individuals in our care. MOLST is the best way for us to facilitate loving and crucial conversations about how we all would want to live out our days.

The Rev. Kenneth V. Daniel, MPA, is president and chief executive officer of United Church Homes, Inc., in Marion (www.unitedchurchhomes.org).