Advance directives and POLST in California

Advance directive and POLST compared

Who needs which

Every adult should have an advance directive. The most important part is naming an agent: the person who will make health care decisions if you cannot. Choose someone who knows you, will be reachable and will follow your wishes even when it is hard. Then talk with them. The conversation matters as much as the paper.

Add a POLST when you have a serious illness, such as the conditions in our condition guides, or when you are frail and want to be clear about CPR and hospital care. A POLST is always voluntary. No facility, plan or hospice may require you to complete one. It does not replace the advance directive, because it does not name an agent.

If a person can no longer make decisions and has no advance directive, California law allows doctors to turn to family or others who know the person best. This can work well, and it can also lead to conflict. A signed directive avoids the question.

Where to get the forms

• Advance Health Care Directive: the California Attorney General's office publishes an advance directive form and plain instructions at oag.ca.gov. Hospitals, health plans and many doctors also hand out forms. California does not require one specific form. You do not need a lawyer to complete it, though some people choose to use one.
• POLST: the current California form, in many languages, is at capolst.org. Do not fill it out alone. It is completed in a conversation with your doctor, nurse practitioner or physician assistant, who must sign it.
• Help filling them out: a hospital or hospice social worker or chaplain can explain the sections and help you think about your choices. They cannot choose for you.

How to put your wishes in writing

1. Step 1

   Think about what matters

   What makes a day good? What would you not want to live through? Where do you want to be cared for?

2. Step 2

   Choose your agent and a backup

   Ask them first. Tell them what you decided and why.

3. Step 3

   Complete the advance directive

   Sign it in front of two qualified witnesses or a notary. The form explains who may not act as a witness.

4. Step 4

   Ask your clinician about a POLST

   If you have a serious illness, go through the form together so the orders match your goals.

5. Step 5

   Share copies

   Give copies to your agent, family, doctors, hospital and hospice. Keep the POLST where a paramedic could find it, such as on the refrigerator or by the bed.

6. Step 6

   Review

   Look at both again after a hospital stay, a new diagnosis or a change of mind.

How hospice uses these forms

At the admission visit, the hospice nurse asks whether the person has an advance directive or a POLST and places copies in the record. If there are none, the team offers information and help. You do not need either form to receive hospice, and you do not need a do-not-resuscitate order to be admitted. Federal rules do not allow a hospice to make care depend on having an advance directive.

The team builds the plan of care around what the forms and the person say. If the person cannot speak for themselves, the team turns to the agent named in the directive. If wishes change, the nurse and hospice doctor can help update the POLST. For what else happens at the start of care, see what to expect in the first week.

Common questions