Imagine your aging parent has a sudden medical emergency and cannot speak for themselves. In that critical moment, who will tell the doctors and paramedics what treatments they want, or more importantly, what they do not want?
This is not a hypothetical scenario; it’s a frightening reality many families face. Even with a living will or general advance directive, emergency responders are often required by law to provide aggressive, life-sustaining treatment unless they have immediate access to a particular, actionable medical order.
This is precisely why a POLST form is so vital. More than a document, a Physician Order for Life-Sustaining Treatment (POLST) is a powerful, brightly colored medical order that accompanies your loved one to ensure their end-of-life care wishes are honored in any setting.
Understanding why your older adult may need one can be the key to protecting their dignity and ensuring their choices are respected when it matters most.
A POLST Form Supplements a Living Will
One of the main goals of end-of-life planning is to help your older adult document their wishes.
That way, their preferences can still be carried out even if they’re not able to speak for themselves. A living will like the Five Wishes form helps with this.
Another document that may benefit some older adults is the POLST form. It’s a separate document that covers explicitly end-of-life treatment preferences.
Emergency medical personnel and hospitals must follow POLST instructions because they are a signed physician’s order.
We explain what a POLST is, why someone might want it in addition to their living will, who typically uses it, what treatments it covers, and which states legally recognize the POLST form.
What is a POLST Form?
POLST stands for Physician Orders for Life Sustaining Treatment. It also has different names in different states.
It’s a medical form that’s legally recognized in many U.S. states and explicitly outlines the end-of-life treatments someone does or doesn’t want.
However, a POLST is not the same as a living will or advanced directive.
It’s a simple one-page document that’s usually printed on bright pink paper, so it’s easy for EMTs and medical staff to recognize.
Medical personnel must follow the instructions on a POLST.
Why Should Someone Have a POLST and a Living Will?
Someone who is committed to their end-of-life choices may want to have a POLST in addition to a living will.
This is needed because if somebody isn’t breathing or doesn’t have a heartbeat, EMTs and medical staff are required to begin CPR and provide complete medical treatment immediately – no matter the person’s age, medical condition, or even if they have a living will saying they don’t want this treatment.
If someone doesn’t want CPR or invasive treatments, having a signed living will isn’t enough to stop them from happening because a living will isn’t a doctor’s order.
So, if your older adult feels strongly about not being resuscitated or given aggressive treatments during an emergency, having a POLST available will ensure that their wishes will be fulfilled.
VIDEO: DNR vs POLST: Which One Do I Need?
Who Typically Would Want a POLST?
Seriously ill or frail patients typically use a POLST.
It allows them to choose the treatments they do or don’t want specifically.
It ensures their wishes are honored, especially by emergency medical personnel, hospital staff, and assisted living and nursing home staff.
What Does the POLST Form Cover?
The POLST form is very straightforward.
There are three sections with checkboxes to select specific preferences about three types of treatment:
Do you want CPR?
What level of medical interventions do you want?
Do you want a feeding tube?
Which U.S. States Legally Recognize the POLST Form?
POLST isn’t yet legally recognized in every state in the United States.
Check the National POLST website to see if it’s recognized in your older adult’s state and to get additional details.
Final Thoughts About a POLST Form for Aging Adults
Completing a POLST form is one of the most profound acts of love and respect you can undertake for an older adult with a serious illness. It transforms vague wishes into clear, actionable medical instructions, providing invaluable peace of mind for everyone involved.
This conversation may feel difficult, but it empowers your loved one to retain control over their medical care and spares family members from the agony of guessing during a crisis. While a POLST is a critical tool, it is part of a larger plan that should also include a comprehensive advance directive and regular discussions about values and goals.
Taking these steps ensures that, no matter what the future holds, your loved one’s voice will be heard and their choices honored with compassion and clarity.
Next Steps: Find out more about POLST at National POLST
Recommended for you:
- The Reality of CPR for Seniors: Get the Facts
- What Is a DNR and Why Would Seniors Want One?
- The Five Wishes Living Will Makes It Easier to Plan for End-of-Life
About the Author
Connie is the founder of DailyCaring.com and was a hands-on caregiver for her grandmother for 20 years. (Grandma made it to 101 years old!) She knows how challenging, overwhelming, and all-consuming caring for an older adult can be. She also understands the importance of support, especially in the form of practical solutions, valuable resources, and self-care tips.
My mum had a POLST form. It was with her when she went into the hospital for an overnight infusion of an antibiotic for a uti. I left her at 12:30 a.m. and went back to get her at 7 a.m. She was unconscious. The hospitalist had given her ativan and fentanyl, *and* the wrong antibiotic. They never checked her POLST form; a copy was in her hospital file, *and* she had a physical copy with her when she was admitted.. Mum died five days later.
That’s terrible and we’re so sorry for your loss. The hospital should have followed the POLST and it sounds like they may have made mistakes in her treatment as well.
Being a marketer for hospice, we always honored the POLST form but we always informed the patients or family what it means to be resuscitated and the injury that can happen. Most of our patients opted for no life saving measures unless it was a fairly non invasive procedure or therapy. The POLST gives a lot more options than the DNR (Do not resuscitate).
Thank you for sharing this helpful insight.
Unfortunately, a POLST doesn’t always work. I’ve heard stories of ER physicians ignoring the POLST and even saying they don’t care that the patient has a POLST, and then going on their merry way and doing everything the POLST says they can’t do. In one particular case, the ER physician revived the patient, admitted the patient to the hospital, and it took the patient’s relatives weeks to convince the hospital to let the patient go home to die. This hospital did everything they could to ignore the patient’s and family’s written wishes.
It’s terrible that happened! However, it’s important to note that having a POLST is better than not having one at all (if the person is firm about what they do or don’t want).
Not having one means that there is no chance of having the patient’s exact wishes followed. At least if a POLST exists, there is a legally-recognized medical order to show to medical personnel. Typically, a POLST will be honored.
But unfortunately, having medical professionals refuse to follow a POLST seems to be a gray area in the law. The National POLST Paradigm website has a legislative guide here — http://polst.org/wp-content/uploads/2017/02/2014.02.20-POLST-Legislative-Guide-FINAL.pdf
In their document, Issue 9 on page 21 addresses the situation you’ve described.
One way to prevent this situation from happening is to make sure ahead of time that the POLST will be valid at the hospital the person would most likely be brought to in an emergency. If the person has a record at that hospital, the POLST should be able to be entered into it.