POLST Forms and Hospice Care

A POLST is not required for hospice. It is an optional set of portable medical orders, signed by a health care provider, that tells emergency responders and clinicians whether to attempt CPR, how much medical treatment to give, and whether to use a feeding tube. It travels with a seriously ill patient between home, ambulance, hospital, and nursing facility, which is why many hospice families choose to have one.

Is a POLST required for hospice?

No. Neither a POLST nor a DNR is a condition of enrolling. To start the Medicare hospice benefit, a physician certifies a prognosis of six months or less if the illness runs its normal course, and the patient or representative signs an election statement. The federal list of what that election statement must contain (42 CFR 418.24) does not include a DNR or POLST. Separately, federal rules bar hospices and other Medicare providers from conditioning care on whether a person has signed an advance directive (42 CFR 489.102). The National POLST program likewise describes the form as entirely optional.

A POLST is still worth discussing with the hospice team, because it is the document responders can act on immediately if someone outside the hospice is called.

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, LST, or another name. Unlike a living will, which records your wishes, a POLST turns current wishes into actual medical orders. It typically covers:

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

The National POLST program says the form is intended for people who are seriously ill or have advanced frailty, which describes most hospice patients. Healthy adults are better served by an advance directive.

POLST vs. DNR vs. advance directive

A POLST is broader than a DNR and complements, rather than replaces, an advance directive. The advance directive names your decision-maker and records broad wishes; the POLST turns current wishes into orders that responders can follow without interpretation. That matters for patients who move between settings or whose family members may call 911 under stress.

What goes on the form, section by section

State forms differ, but most are organized into a few labeled sections:

• 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, to limited interventions, to full treatment (including intensive care and breathing machines).
• Artificial nutrition. Records whether the person wants a feeding tube, a trial period, or no artificial feeding.

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

Who fills out and signs a POLST in hospice?

The form is completed in a conversation between the patient (or their decision-maker) and a health care provider; the National POLST program says patients should not be handed the form to fill out on their own. The provider must sign it for it to be valid, and most states also require the patient or the patient's surrogate to sign. Which types of clinicians may sign depends on state law. On hospice, the hospice physician or your own doctor can complete it as part of advance care planning; ask the hospice who on the team handles it.

How a POLST works in different settings

The form's value is that it follows the patient. Under the U.S. Department of Veterans Affairs advance care planning policy, a state-authorized portable order is a form or identifier, authorized by state law or the state medical board, that turns a patient's treatment preferences into standing portable medical orders. Exactly who must honor a POLST, and how, is set by each state's law. In practice:

• At home on hospice: keep the form where responders will see it. The National POLST program suggests the refrigerator or medicine cabinet.
• In a nursing home or assisted living: the form goes in the resident's chart, so staff can follow it instead of defaulting to a hospital transfer.
• In an ambulance or hospital: send the form (or a copy) with the patient. The National POLST program says faxed and photocopied forms are valid in almost all states.

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

Correcting common misconceptions

"A POLST replaces my advance directive." No, they work together. 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, and the hospice team can help update it.

"A POLST means giving up." No. Comfort-focused orders are a plan for the care you do want, and the interventions section also allows limited or full treatment if that matches the goals.

Frequently asked questions

Can a hospice require a DNR or POLST?

No federal rule makes a DNR or POLST a condition of Medicare hospice: the required contents of the election statement (42 CFR 418.24) include neither, and hospices may not condition care on whether you have signed an advance directive such as a living will or health care power of attorney (42 CFR 489.102). If a hospice tells you otherwise, ask them to show the requirement in writing. See does hospice require a DNR.

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 level of medical intervention and artificial nutrition.

Does a POLST work in another state?

Not always. POLST programs are state-authorized and forms differ. If a patient moves or travels, ask clinicians in the new state whether the existing form will be honored or whether a new one is needed. VA medical facilities follow a national policy (VHA Directive 1004.03, December 2023) to honor a valid state-authorized portable order from any state that limits life-sustaining treatment, even in an emergency, unless there is evidence it no longer reflects the patient's wishes; see hospice care for veterans.

Can a POLST be changed or cancelled?

Yes. A POLST can be changed or voided at any time. Ask the hospice to help complete a new form when goals change, and replace every copy so old orders are not followed by mistake.

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 clear to anyone outside the hospice who responds.

Questions to ask the hospice team

• Does our state use POLST, MOLST, POST, or another version, and does it fit our situation?
• Will you help us complete and sign it, and who on the team handles advance care planning?
• Where should we keep the original, and who should get copies?
• If we transfer to a hospital or facility, what should we hand to the staff?
• 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 health care provider; it is not valid until the provider signs it, and rules vary by state.
• Keep it where responders will see it 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.