POLST Guidance for Caregivers
If you are caring for someone who is living with a serious illness, a chronic health condition, at an advanced age or near end of life, there are steps you can take to help them prepare for what is ahead. It is important to understand their wishes and preferences to be able to advocate for them when and where needed.
1. Encourage Completion of Advance Directives and/or POLST
When someone is living with serious illness or is at an advanced age, it becomes especially important for their loved ones to document how they want to be cared for in a medical emergency—and who should speak for them if they can’t speak for themselves. An Advance Directive is the best tool for naming a decision maker and outlining values, goals, and general care preferences.
A POLST adds another layer of clarity when a person wants to limit life‑sustaining treatments or avoid certain medical interventions. Because it’s a medical order, it guides emergency responders and clinicians in real time.
When caring for someone whose health is changing or whose age increases their vulnerability, it’s wise to encourage completion of both documents. Together, they ensure that care aligns with the person’s values, their wishes are understood, and their voice remains present even if they can’t communicate.
2. Revisit Care Preferences as Health Changes
Advance Directives and POLST forms aren’t “set‑and‑forget” documents. They need to be revisited as a person’s health shifts, their goals evolve, and age brings new realities. This is especially crucial for anyone at risk of losing decision‑making capacity in the future, such as those living with dementia or cognitive decline.
Regularly updating these documents ensures that current wishes—not outdated assumptions—guide care. When preferences are clearly documented and shared, a surrogate decision maker can step in with confidence, knowing they’re honoring the person’s values rather than guessing in a crisis.
Keeping these tools current is one of the most reliable ways to make sure care aligns with what matters most.
3. Align Care Goals Even if Decision Making is Altered
When someone has already lost decision‑making capacity, they can no longer complete legal documents like an Advance Directive or a Power of Attorney. Those tools require the person to understand their choices and sign for themselves.
A POLST, however, is different. Because it’s a medical order—not a legal document—it can be completed and signed by a surrogate decision maker. This allows the care team to continue honoring the individual’s previously expressed values and treatment preferences, even if they can no longer speak for themselves.
Updating or completing a POLST through a surrogate ensures that medical interventions stay aligned with what the person wanted, not what others assume they might want. It’s one of the most effective ways to keep their voice present in their care.
Understanding Advance Directives vs. POLST
Advance Directives
For all adults.
Appoints healthcare agent/surrogate.
Typically used in hospital to guide care when one can't communicate for themselves.
General instructions for treatment in specific medical scenarios, how long to continue medical intervention and hoped for outcomes.
Various forms and version available.
Signed by:
Individual
Two Witnesses or Notary (either or, but not both)
POLST
For those living with illness, medical frailty or at later stage of life.
Specific medical orders guiding life-sustaining treatment out of hospital when one can not communicate for themselves.
Does not appoint healthcare agent/surrogate.
One standardized form.
Signed by:
Patient or Surrogate Decision Maker
Physician, NP, or PA