Everyone needs an Advance Directive – Not everyone needs a POLST

Remember: Everyone needs an Advance Health Care Directive – Not Everyone needs a POLST

Many people in our community have heard about POLST (Provider Orders for Life Sustaining Treatments) and it is widely used across the state. There are significant differences between an Advance Directive and a POLST. These forms have different purposes and are used in different ways.

Advance Directive

1) Purpose
An Advance Directive is for all adults 18 and older, while a POLST is for those with an advanced progressive chronic condition. A POLST is for those with a life-limiting condition. The question to ask to determine if someone is appropriate for POLST is: “Would you be surprised if this person died in the next year?”

2) Time frame
An Advance Directive is for future care, while a POLST is a portable medical order for current care.

3) Location
An Advance Directive can be completed anywhere by the person. A POLST is completed in a healthcare setting as it is signed by either a physician or Advance Practice Nurse.

4) Who completes
An Advance Directive is completed by the person and is valid with 2 witnesses or being notarized.

A POLST is medical order that is completed by a physician or Advance Practice nurse. It is done in consultation with the patient or agent, but must be signed by the medical provider.

5) Updates
When you update an Advance Directive, be sure to make copies of the newest document available to your agent, loved ones and doctor. Similarly, if a doctor or nurse updates a POLST, creating a new medical order, that latest version should be shared widely, including in the medical record.

More on POLST

Background information on POLST on the Kokua Mau website

Everyone needs an Advance Directive – Not everyone needs a POLST

Advance Directive and POLST (Provider Orders for Life Sustaining Treatments) are both very important to document your wishes for care. To clarify the strengths and differences, we have created this chart.

The Advance Health Care Directive, commonly known as an Advance Directive, allows you to appoint your Health Care Power of Attorney the person who can speak for you if you cannot speak for yourself in a medical situation. It also allows you to specify your wishes for care at the end of life. There are many versions of the Advance Directive and you can download a free version at here. Everyone 18 years and older needs an Advance Directive.

POLST is a portable medical order that takes effect as soon as it is signed. It can follow you from home into a medical setting, and after discharge to your home or other setting such as a nursing or care home. POLST is a form that contains medical orders that specify the type of care you would like in the event of a medical emergency. This form can be quickly understood by all healthcare professionals, including first responders and ambulance personnel. Transferable to all healthcare settings, POLST must be a signed by a physician or APRN to be valid.

PurposeExpress wishes for future end of life care and appoints a health care power of attorney(s)Portable Medical Order which turns a patient’s wishes to action in a medical emergency
Who Needs It?All Adults 18+ of sound mindSeriously Ill or frail at any age
Treatment FocusIn the future if you cannot speak for yourselfRight now – based on your current medical condition
Whom Completes?Individual (you)Doctor or Advance Practice Registered Nurse (APRN) & patient or legally authorized representative
Appoints Healthcare Agent?YESNO
Guides Emergency Room Decisions?YESYES
EMS Honors it?NOYES

Key Kōkua Mau materials, including the Advance Directive and POLST, are translated into 10 languages