Common Questions from Webinar on Resident Rights and Alternate Decision Makers

Q: Is the Green Polst Form accepted by Washington State as an advanced directive? Does the DPOA have the right to change a POLST form that is signed by client previously when of sound mind? Often when a client loses capacity the DOPA go into effect and the DPOA's will change the polst to their preference.  Perhaps the Polst form that was originally signed as Do not Resuscitate but now the DPOA does not want them to die. How do we protect the resident's original desires? 

A: The Physician Orders for Life Sustaining Treatment (POLST) form is a "portable" physician order form that describes the patient's code directions. It represents a way of summarizing wishes of an individual regarding life sustaining treatment identified in an advanced directive such as a Health Care Directive or Durable Power of Attorney for Health Care. It may be helpful to seek legal advice on how to proceed if you know the DPOA has changed the POLST and it is not the resident’s original wishes.

Q: As an adult family owner, I frequently have guardians instruct the AFH to prevent visitors, phone calls, computer access, and mail to “protect” the client.  This is often completely against the resident’s wishes. 

What do we do when the guardian removes their client from an activity that the client enjoys either to prevent them from seeing former friends or convenience to the guardian?

A:  Here are some factors you want to consider:
-	What does the assessment of the resident include:
-	What does the care plan state?  

You will also want to discuss with the decision-maker about the resident right requirements. Your local Ombuds may be a good resource as well. 

Q: Adult Family Homes are unlike NH, and AL. We are small and offer a home like environment in a home. Not all homes provide 24 hour hourly care. Is it your expectation for AFH to hire 24 hour hourly staff to accommodate visitors? Is it unreasonable to expect the resident to visit on the weekend or off day?

A:  AFH WAC 388-76-10595 requires the adult family home to not interfere with the resident’s right to have access to and from immediate family members or other relatives of the residents and others who are visiting with the consent of the resident, subject to reasonable limits to protect the rights of others and to the resident’s right to deny or withdraw consent at any time.

Q: If a state funded resident seems to be in need of some type of decision maker, but none is currently identified, what role does HCS or DDA case management play in coordinating/arranging assistance?

A: If the individual is self-neglecting because he or she cannot make decisions and is incompetent, a referral could be made to APS which can assist with guardianships in some instances.  DDA also sometimes petitions for guardianships on behalf of its clients but HCS does not.  We would encourage you to consult your own counsel about options.  

Q: Regarding decision maker being unable to detain a resident, does that apply to a memory care or secure unit of a facility? 
A: RCW 11.92.190 states that no residential treatment facility which provides nursing or other care may detain a person within such facility against their will. This includes a memory care or secure unit.

Q: With regards to a DPOA.  If the resident decides to complete a DPOA while at a facility and does not want it to be notarized (even though it is recommended) we can have two individuals not associated with the resident’s healthcare or kin witness the DPOA.  If at a SNF can we have other staff not associated with the SNF (out sourced therapy staff) sign and witness the DPOA?

A:  We would encourage you to consult with your own counsel about who can be an appropriate witness to a DPOA.

Q: How do we get HCS to assist clients and providers that need assistance with modifying resident rights?

A:  Residents are afforded resident rights under both statute and rule and resident rights cannot be modified.

***For other questions, here are resources that can help you:
Washington State Long-Term Care Ombuds vickie@mschelps.org
Leading Age LeighBeth Merrick lmerrick@LeadingAgeWA.org
Washington Health Care Authority Elena Madrid Elenamadrid@WHCA.ORG
AFH Council Susan Zarenski susan@ADULTFAMILYHOMECOUNCIL.ORG
Residential Care Services RCSPolicy@dshs.wa.gov