POLST Forms and Hospice Care

A POLST is a portable set of medical orders, signed by a clinician, that travels with a seriously ill patient across settings, home, ambulance, hospital, or nursing facility, so emergency responders and clinicians honor the person's treatment wishes. It is optional for hospice, but for many families it is the clearest, most actionable way to make sure those wishes are followed in a crisis.

What POLST means

POLST stands for Physician (or Portable) Orders for Life-Sustaining Treatment. Depending on your state it may be called POLST, MOLST, POST, MOST, or a similar name. Unlike a living will, which records your wishes, a POLST converts those wishes into actual medical orders that any clinician can follow immediately. It typically covers:

• Whether to attempt CPR if the heart stops
• The level of medical intervention desired (comfort-focused, limited, or full treatment)
• Wishes about artificial nutrition (such as feeding tubes)

POLST vs. DNR vs. advance directive

A POLST is broader than a DNR and is meant to complement, not replace, an advance directive. A POLST is most appropriate for people who are seriously ill or frail, which describes most hospice patients.

The practical difference matters most in an emergency. A living will may sit in a drawer and require interpretation; a POLST is a recognizable, clinician-signed order that responders act on right away. That is why many hospice social workers encourage a POLST for patients who move between settings or who have family members likely to dial 911 under stress — it removes guesswork at the worst possible moment.

Is a POLST required for hospice?

No. A POLST is not required to enroll in hospice, and neither is a DNR. Hospice enrollment requires a physician's terminal certification and a signed election statement. A POLST is a tool that helps the hospice team and outside responders honor the comfort-focused plan, especially when care happens outside the home or when 911 might otherwise be called.

What goes on the form, section by section

Most state POLST forms are organized into a few clearly labeled sections, and understanding them helps a family fill one out thoughtfully:

• CPR / resuscitation. Applies only if the person has no pulse and is not breathing. You choose “attempt CPR” or “do not attempt resuscitation.” This is the section that overlaps with a DNR.
• Medical interventions. Applies when the person has a pulse and/or is breathing. Options usually range from comfort-focused care (treat symptoms, avoid the hospital when possible), to limited interventions (treat but avoid intensive measures), to full treatment (including the ICU and breathing machines).
• Artificial nutrition. Records whether the person wants a feeding tube, a trial period, or no artificial feeding. Hospice teams can explain how this connects to comfort at the end of life.

Because these are orders rather than wishes, every box should reflect a real conversation about goals — not a default someone checked in a hurry.

Why a POLST helps hospice families

Because it is a portable medical order that responders are trained to follow, a POLST reduces the risk of unwanted interventions during a transfer or after-hours event. It is particularly useful when:

• The patient moves between home, a facility, and the hospital
• A caregiver is unsure what to do and someone calls 911 by reflex
• Multiple family members or providers are involved and wishes must be unambiguous

Even with a POLST, remember the hospice rule: for a symptom crisis or at the time of death at home, call the hospice first, not 911. See do you call 911 when a hospice patient dies.

How a POLST works in different settings

The form's value is that it follows the patient. In a nursing home or assisted living, staff are typically required to honor a valid POLST, which prevents a reflexive 911 call and an unwanted hospital transfer. In an ambulance, EMS crews in POLST states are trained to follow it rather than automatically performing full resuscitation. In the hospital, it travels into the chart and guides the admitting team until new orders are written. At home on hospice, it backs up the hospice plan of care so that if anyone outside the household responds, they see the orders immediately. Keep the original where it can be found fast — many states print it on brightly colored paper for exactly this reason.

Correcting common misconceptions

"A POLST replaces my advance directive." No, they work together. The advance directive names your decision-maker and records broad wishes; the POLST turns current wishes into orders for clinicians. If you want to understand who speaks for the patient, see hospice and power of attorney.

"A POLST locks me in." No. You can change or void a POLST at any time as goals change; the hospice team can help update it.

"Everyone should have one." POLST is designed for the seriously ill or frail, not healthy adults, who are better served by an advance directive alone.

"A POLST means giving up." No. Choosing comfort-focused orders is a positive plan for the care you do want, and you can still opt for limited or full treatment in the interventions section if that matches the goals.

Frequently asked questions

Who can sign a POLST?

A POLST must be signed by a licensed clinician — typically a physician, and in many states a nurse practitioner or physician assistant — to become valid medical orders. The patient or their authorized decision-maker also signs or consents. The hospice physician can complete one as part of advance care planning.

Does a POLST work in another state?

Not always. POLST programs are state-specific, and recognition across state lines varies. If a patient moves or travels, ask the new state's clinicians whether the existing form is honored or whether a new one is needed.

Is a POLST the same as a DNR?

No. A DNR addresses only whether to attempt CPR. A POLST includes that decision but also covers the broader level of medical intervention and artificial nutrition, making it more complete for someone who is seriously ill.

What if there's no POLST when an emergency happens at home?

Call the hospice's 24/7 line first; the team guides you and can come to the home. A POLST simply makes wishes unambiguous to anyone who responds. Hospice does not require a POLST or a DNR to provide care.

Questions to ask the hospice team

• Does our state use POLST, MOLST, POST, or another version, and does it apply to our situation?
• Will you help us complete and sign it, and who on the team handles advance care planning?
• How should we store the original, and how many copies should we make?
• If we transfer to a hospital or facility, what should we hand to the staff?
• How and how often should we review the form as goals change across benefit periods?

Practical next steps

• Ask the hospice physician or your doctor whether a POLST (or your state's equivalent) fits the goals of care.
• Complete it with a clinician; it must be signed to be valid, and rules vary by state.
• Keep the form visible at home (many states use a brightly colored form) and send a copy with the patient during any transfer.
• Give copies to the hospice and the health-care proxy; learn about proxies in hospice and power of attorney.
• Review it at each benefit period or whenever wishes change.

A strong hospice will help you complete and update a POLST as part of advance care planning. If you are still choosing, compare hospices near you and ask how their social workers support these documents.