IN SHORT: An Advance Directive and a POLST can help make your parent’s healthcare wishes clear before a medical emergency. An Advance Directive records healthcare wishes and can name someone to make decisions if your parent cannot speak for themselves. A POLST is a medical order for people who are seriously ill or have advanced frailty and can include decisions about CPR, DNR, medical treatment, and artificial nutrition. Talking about these wishes early and keeping the documents easy to find can help families feel more prepared.
Talking about end-of-life care can be difficult. But knowing your parent’s wishes before an emergency happens can make a difficult situation a little easier for everyone.
Two documents can help families plan ahead: an Advance Directive and a POLST.
An Advance Directive allows a person to document their healthcare wishes and name someone they trust to make healthcare decisions if they are unable to speak for themselves. It is important to share a copy with your doctor and hospital so it can be included in your medical records and available when needed.
A POLST (Provider Orders for Life-Sustaining Treatment) is different. It is a medical order generally intended for people who are seriously ill or have advanced frailty. It communicates specific treatment wishes to healthcare professionals if the person cannot speak for themselves. A POLST does not replace an Advance Directive.
Who Signs These Documents?
The two documents are signed differently. In Minnesota, an Advance Directive is signed by the person creating it and verified by a notary or two witnesses. A POLST must be signed by a physician, APRN, or PA to become a medical order.
Talking with your healthcare provider about these documents can help make sure your wishes are clearly understood and documented.
What Choices Are on a POLST?
A POLST addresses several important decisions:
CPR or DNR: A person can choose whether they want CPR attempted if their heart stops or they stop breathing. “Yes CPR” is sometimes called Full Code, while “No CPR” is generally called DNR (Do Not Resuscitate). DNR applies specifically to CPR; it does not mean that other medical care stops.
Level of treatment: A person can choose Full Treatments, Selective Treatments, or Comfort-Focused Treatments. These choices communicate how much medical treatment they would want if they become seriously ill.
Artificial nutrition: The POLST can also address whether a person wants medically assisted nutrition, such as through a feeding tube.
These are personal decisions that should be discussed with a healthcare professional. A POLST is completed with the person’s healthcare team.
When Should You Talk About It?
There is no need to wait for a medical crisis. The best time to talk about healthcare wishes is before they are needed. Consider having the conversation when your parent is healthy and able to clearly express what matters to them.
It is also a good idea to review these wishes after a major change in health, a new diagnosis, hospitalization, change in living situation, or change in treatment preferences.
Can These Documents Be Changed?
Yes. Your parent can change or cancel an Advance Directive if their wishes change and they are able to make and communicate that decision. A POLST can also be replaced or voided when a person’s wishes change, but because it is a medical order, the change should be discussed with a healthcare professional and a new POLST completed when needed.
Where Should a POLST Be Kept?
Keep the original in an easy-to-find place at home, such as on the refrigerator or another clearly visible location. Make sure family members and caregivers know where it is.
If your parent lives in assisted living, a nursing home, or another care setting, ask staff where the POLST is kept and how it will be accessed in an emergency. Patients should also keep a copy readily available when they are away from home.
The most important thing is not simply having the document. It is having the conversation, understanding your parent’s wishes, and making sure the people who may need to help know what those wishes are.
Learn more about POLST: National POLST - Patient Resources
Find your state’s POLST resources: National POLST State Program Directory
Learn more about Advance Care Planning in Minnesota: Minnesota Department of Health - Advance Care Planning