Homeliving Health Providers, Inc. recognizes that all adult persons have a fundamental right to make decisions relating to their own medical treatment, including the right to accept or refuse medical care.  It is the policy of Homeliving Health Providers, Inc. to encourage individuals and their family/caregivers to participate in decisions regarding care and treatment.  Valid Advance Directives, such as living wills, Durable Power Of Attorney for Health Care, and DNR (Do Not Resuscitate) orders will be followed to the extent permitted and required by law.  In the absence of Advance Directives, Homeliving Health Providers, Inc. will provide appropriate care according to the plan of care or as authorized by the attending physician.  Homeliving Health Providers, Inc. will not determine the provision of care or otherwise discriminate against an individual based on whether or not the individual has executed an Advance Directive.

• Upon admission, the clinician will provide information regarding a patient’s right to make decisions concerning health care, which include the right to accept or refuse medical or surgical treatment, even if that treatment is life-sustaining, the right to execute Advance Directives, and applicable organization policies. Written information designed for this purpose will be provided to the adult patient. The clinician will document in the clinical record that the information was provided and record all discussions concerning Advance Directives.
• If the patient lacks decision-making capacity, the admitting clinician will provide information and direct inquiry about Advance Directives to the patient’s representative. The clinician will document that the patient representative received information, and his/her name and responses will be noted in the clinical record.
• If conditions are such that it is not practical to provide information to the patient or his/her representative at the time of admission, such information will be provided as soon as feasible after admission.
• During the admission visit, the clinician will ask the patient or his/her representative whether or not he/she has completed an Advance Directive, Durable Power of Attorney (DPOA), living will, or DNR order. If an Advance Directive has been completed, the clinician will ask for a copy of the Advance Directive so it will be placed in the clinical record.  If a copy is not immediately available, the patient will be informed that it is his/her responsibility to provide a copy of the Advance Directive to the organization as soon as possible.
• If a copy of the patient’s Advance Directive is not available to the organization, the clinician will discuss the contents of the Advance Directive with the patient and/or patient representative and document the contents of the Advance Directive in the clinical record and communicate the contents to other home health providers.
• When applicable, the admitting clinician will document on the clinical record and notify the attending physician verbally of the physician’s (or other authorized licensed independent practitioner’s) order if the patient has executed an Advance Directive.
• The patient will be encouraged to participate in all aspects of decision-making regarding home health care and treatment. Statements by a competent patient regarding his/her desire to accept or refuse treatment will be documented in the patient’s clinical record.
• The patient will be informed of any limitations Homeliving Health Providers, Inc. has in respecting the patient’s Advance Directive.
• All clinicians providing care for the patient will:
  • Review the Advance Directive and report any discrepancies between the Directive and current treatment plan to the attending physician, clinical supervisor, and the patient.
  • Utilize available educational materials to answer the patient’s questions about Advance Directives, durable power of attorney, or living wills.
  • Encourage the patient to discuss questions and concerns with appropriate individuals such as the physician, family/caregiver, and his/her selected advocate.
  • Assist the patient who wants to develop an Advance Directive by obtaining a form and providing access to the outside individuals as necessary to execute the directive.
• An Advance Directive will be implemented as follows:
  • The Durable Power of Attorney for Health Care/Advance Directive is effective only when the patient is unable to participate in his/her own medical treatment decisions.
  • The attending physician and another physician or a licensed psychologist must document in the patient’s clinical record that the patient is unable to participate in medical treatment decisions.
  • The patient’s designated advocate can then make medical treatment choices based on the Advance Directive. The patient advocate may make a decision to withhold or withdraw treatment that allows the patient to die.  This is done only if the patient expressed, in a clear and convincing manner, that the advocate is authorized to make such a decision, and acknowledges that such a decision would or could allow the patient’s death.
  • Executing and implementing an Advance Directive is a process, not a one (1)-time event. On an ongoing basis, the clinical staff will keep the patient, family/caregiver, and patient’s representative up to date concerning the patient’s medical condition. They will discuss the patient’s preferred course of treatment as his/her condition changes.  The discussions will be documented in the clinical record.
• Educational information about Advance Directives and Homeliving Health Providers, Inc.’s policies and procedures regarding Advance Directives will be provided to the medical, nursing and allied health professionals, as well as home health personnel and volunteers during the orientation period.
• In order to educate the community about Advance Directives, Homeliving Health Providers, Inc. will participate in community forums, as appropriate, and make written materials available regarding Advance Directives.
• The organization will utilize POLST specific forms and guidelines.