Learn What a POLST Form Is, Who It’s For, and How it Helps

What is POLST?

Who is a POLST form for?

A POLST form is meant for people who are very sick or very frail. Normally, when a person becomes unresponsive, healthcare professionals will do everything possible to try to save a life. But for seriously ill and frail people, those treatments can be painful, chaotic, and ineffective. A POLST form lets you clearly state which treatments you want and don’t want, so your wishes are followed if you can’t speak for yourself. If you are healthy, you do not need a POLST form, and an advance directive is the preferred health planning tool.

Example Scenarios

Advanced heart disease: After several hospitalizations for heart failure, Maria knows her heart is getting weaker. She wants to avoid CPR or a ventilator if her heart stops, choosing instead to stay comfortable at home surrounded by family.

Late-stage cancer: John’s cancer has spread and no longer responds to treatment. He talks with his doctor about using a POLST form to request comfort-focused care and avoid aggressive measures like resuscitation or ICU transfer.

Advanced frailty in old age: At 91, Ruth is very frail and spends most of her time in bed. She and her daughter decide to complete a POLST form to document that she wants natural death at home and does not want to be taken to the hospital or given a feeding tube if she stops eating.

Early stage dementia: Tom is 75 and has just been diagnosed with dementia. He manages the activities of daily living well, and shares a home and life with his 75-year-old wife. Tom’s overall health is good. Tom talked to his care team and wants every effort made to be resuscitated, should he suffer a medical emergency. He wants any other illnesses he experiences identified and aggressively treated. Tom will use the options of full interventions and CPR for now, understanding that as his condition changes, it is his option to revisit the POLST form and change it as his preferences change.

How it Works

How the POLST Form Works

For a person with progressive serious illness, falling unconscious at home is very possible. When emergency responders arrive, without clear instructions, they must try everything possible to keep the patient alive – CPR, a breathing tube, or rush transportation to the ICU – even if those treatments are painful or unlikely to help. This is the standard of care that is followed without any communication of patient wishes via advance care planning. A POLST form prevents this by giving EMS and doctors the patient’s exact wishes in the form of a medical order. This tells healthcare providers right away whether to use life-saving treatments and transport you to the hospital or focus on keeping you comfortable in the setting you are in. This supports having the care you receive match what you truly want.

If I already have an advance directive, why do I need a POLST?

Advance directives and POLST forms are both advance care planning tools, but they are not the same.

• An advance directive is a legal document that authorizes someone to make health care decisions for you and spells out your general treatment wishes.
• A POLST form, however, is the translation of a patient’s wishes into a signed medical order, which makes it easier for medical personnel to follow in case of emergency. It contains more specific wishes in the form of an order.

POLST is More Specialized Than Advance Directives

POLST in an Emergency

How will EMS know I have a POLST?

Emergency responders are trained to look for a POLST form. At home, families and care partners are asked to keep the form in an easy-to-find spot, like on the refrigerator or near the bed. In nursing homes or hospitals, the POLST form is placed in your medical chart so staff can give it to emergency medical providers right away. Some states also have electronic POLST registries or bracelets that alert responders so that your wishes can be seen quickly and honored in an emergency.