What Is POLST
POLST (Physician Orders for Life-Sustaining Treatment) is a medical document that translates your end-of-life care wishes into actionable physician orders. Unlike an advance directive, which is a legal document expressing general preferences, POLST is a set of actual medical orders that healthcare providers follow immediately. It focuses on four key decisions: resuscitation, medical interventions, antibiotics, and artificially administered nutrition.
POLST exists in all 50 states, though the form and process vary by state. It's particularly relevant when you're arranging care for an aging parent or chronically ill family member who may need home health aides, hospice services, or transition between care settings. Medicare and Medicaid both recognize POLST orders, and they travel with the person across hospitals, nursing facilities, and home care environments.
Who Needs POLST
POLST is most appropriate for people aged 55 and older or anyone with a serious, life-limiting illness. Your loved one's home care team, including their primary physician and any home health aides involved in their care plan, should know whether POLST exists. If your family member receives Medicaid or Medicare benefits and has multiple chronic conditions affecting activities of daily living (ADLs), POLST conversations become critical during care planning.
POLST becomes especially important when someone transitions from independent living to needing regular assistance with ADLs like bathing, dressing, or medication management. If your loved one is considering respite care, moving to assisted living, or enrolling in hospice, that's the time to address POLST with their physician.
How POLST Differs from Advance Directives
An Advance Directive states your preferences in general terms. POLST converts those preferences into specific medical orders. A POLST form has checkboxes for CPR intensity, the level of medical intervention desired, and whether the person wants a feeding tube or IV fluids. These boxes determine what emergency responders, nurses, and home health aides actually do in a crisis.
You can have both documents. The Advance Directive gives your values; POLST gives your doctor a clear protocol. For someone at home with chronic illness, POLST eliminates confusion about whether to call 911 or keep the person comfortable.
The POLST Process
- Initiate conversation: Your loved one's doctor brings up POLST when prognosis suggests a life expectancy under two years or when the person has serious illness limiting daily function.
- Discuss options: The physician reviews the four sections of the form, explaining what full resuscitation, limited intervention, and comfort-focused care mean in practice.
- Complete the form: The physician and your loved one (or you as healthcare proxy) decide on each section and sign. Some states require witness signatures.
- Distribute copies: Keep a copy at home, give one to the primary care physician, provide one to any home health agency, and give one to the hospital or facility if applicable.
- Update regularly: POLST should be reviewed annually or whenever health status changes significantly. Changes during respite care or after hospitalization are common.
POLST and Home Care
When your family member receives home health aide services, those aides need to know what POLST says. A POLST form specifying comfort-focused care tells the aide to manage pain and dignity rather than attempting resuscitation if the person stops breathing. This prevents emergency interventions that conflict with your loved one's wishes.
If someone is receiving respite care, the respite facility also needs a POLST copy. Many Medicaid waiver programs that fund home and community-based services actually require POLST documentation when individuals have certain diagnoses or functional limitations.
Common Questions
- Can POLST be changed? Yes. Either the person or their healthcare proxy can ask the physician to revise it at any time. There's no waiting period or legal process required. If your loved one's health improves or values shift, a new conversation with the doctor creates a new form.
- What happens if someone doesn't have POLST? Without it, emergency responders default to full resuscitation. Hospital staff must attempt CPR, intubation, and all interventions unless a DNR order exists. For home-based care, this can mean unwanted hospital transfers that interrupt care plans and increase Medicare claims.
- Is POLST covered by Medicare or Medicaid? The conversation and form creation are typically covered as part of a physician visit. Some states have specific reimbursement codes for advance care planning discussions, compensating doctors between $50 and $150 for the time spent reviewing POLST with your family member.
Related Concepts
- DNR (Do Not Resuscitate) - A specific order focusing on CPR alone; POLST is broader and addresses multiple types of life-sustaining treatment.
- Advance Directive - A legal document expressing general care preferences; POLST converts those into medical orders.