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CARES Act Impact on
Retirement Plans and Welfare
and Fringe Benefits
Changes to Group Health
and Retirement Plans
Retirement Plans During
the Pandemic
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resident physicians can complete both the
documentation and orders with patients if
they fall within their scope of practice, unlike
POLST which requires a licensed physician.
Third, veterans at high risk for an adverse
health event in the next one-to-two years
are considered candidates for a goals-ofcare
conversation with LSTDI rather than the
twelve months suggested by POLST.
Research
Twenty years of research has helped
many states look at specific outcome measures
for POLST implementation. In a landmark
study in the Journal of the American
Geriatrics Society, 18,000 death records of
patients with a valid POLST were evaluated,
and they found a strong relationship between
POLST comfort treatment orders and
location of death (only 6% of those patients
died in the hospital compared to similar patients
without a POLST [34%]). 4 Patients with
a POLST were more likely to enroll in hospice
at the end of life, 5-6 and there were significant
associations between POLST use in
the nursing home and the level of treatment
received. 6 We also know that POLST completion
tends to be close to the end of life,
with an average time of 6.4 weeks between
form completion and death. A study by Zive
et al., found that those patients with cancer
had an average of five weeks between POLST
completion and death, and for those with
dementia, the average time was 14.5 weeks. 7
Conclusion
Physicians who care for patients with a
life-limiting illness are encouraged to talk
about care wishes with their patients or surrogate,
including goals of care considering
current diagnosis, prognosis, and treatment
options. The POLST form is a useful tool that
can be used to provide treatments aligned
with patient preferences, and we encourage
all Arkansas physicians to incorporate
POLST into their practice.
References:
1. Arkansas State, Act 504. 91 st General Assembly.
An Act to create the Arkansas Physician
Order for Life-Sustaining Treatment
Act; To provide for the use of a Physician
Order for Life-Sustaining Treatment Form;
and for other Purposes. March 15, 2017.
http://www.arkleg.state.ar.us/assembly
/2017/2017R/Acts/Act504.pdf
2. Gozalo, P., Teno, J., Mitchell, S., Skinner,
J., Bynum, J., Tyler, D., Mor, V. (2011). Endof-life
transitions among nursing home
residents with cognitive issues. The New
England Journal of Medicine, 365, 1212-
1221.
3. Kaspers, P. J., Pasman, H. R., Onwuteaka-Philipsen,
B. D., Deeg, D. J.
(2013). Changes over a decade in end-oflife
care and transfers during the last 3
months of life: A repeated survey among
proxies of deceased older people. Palliative
Medicine, 27, 544-552.
4. Fromme EK, et al. Association between
Physician Orders for Life-Sustaining
Treatment for Scope of Treatment and
in-Hospital Death in Oregon. JAGS; 2014.
62:1246-1251.
5. Pedraza SL et al. Association of Physician
Orders for Life-Sustaining Treatment
Form Use with End-of-Life Care Quality
Metrics in Patients with Cancer. J Onc
Pract 2017 Oct; 13(10) e881-e888).
6. Jennings LA, Turner M, Keebler C, Burton
CH, Romero T, Wenger NS, Reuben DB
(2019). The Effect of a Comprehensive
Dementia Care Management Program on
End-of-Life Care. Journal of the American
Geriatrics Society. First published: 24 January
2019.
7. Zive DM, Fromme EK, Schmidt TA, Cook
JN, Tolle SW. Timing of POLST form Completion
by Cause of Death. J Pain and
Symptom Management. 2015 Nov: 50
(5):650-8.
_________________________________
Dr. Sarah Beth Harrington is the director
of the UAMS Division of Palliative Medicine
in the Department of Internal Medicine and
Chief of Palliative Care at the Central Arkansas
Veterans Healthcare System. Dr. Heather
Moore is an internist and palliative care specialist
at UAMS and CAVHS. Dr. Masil George
is a geriatrician and palliative care specialist
at UAMS in the Department of Geriatrics and
Chair of the Arkansas POLST program. Dr. David
Smith is a cardiologist and palliative care
specialist and director of supportive care at
Baptist Health Little Rock.
64 • The Journal of the Arkansas Medical Society www.ArkMed.org