POLST and MOLST forms — medical orders that travel with the patient
This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.
Your father has been declining for months. His dementia is progressing. He has heart disease. He's in a nursing home, and everyone involved in his care knows that he's approaching the end of his life. The conversations with his doctors have been about comfort, not cure. But last week he aspirated some food and developed pneumonia. The nursing home called an ambulance. He was admitted to the hospital. Once there, he was treated aggressively—antibiotics, supplemental oxygen, constant monitoring. He was scared and confused. Three days later, once the acute crisis was managed, the hospital contacted you asking what to do next.
This scenario plays out the same way in hospitals across the country because there's a gap between what people want at the end of their lives and what actually happens. People say they want comfort care. They say they don't want to be on machines. But the moment they go to the hospital with an acute problem, the hospital treats it as an acute problem. That's what hospitals do. Unless there's a very specific document in place, hospital staff will treat the acute event, not respect the person's overall wishes.
That document is called a POLST form in some states and a MOLST form in others. The names vary, but the purpose is the same. It's a medical order. It's not a general statement about your values. It's an actual order that tells emergency responders and hospital staff what you do and don't want. Understanding what this form is, how it differs from other advance planning documents, and when your parent needs one can change the quality of their final weeks and months.
Understanding the Basics
POLST stands for Physician Orders for Life Sustaining Treatment. MOLST stands for Medical Orders for Life Sustaining Treatment. Some states use different names. Some call it MOST, MOLST, COLST, or something similar. The acronyms vary by state, but they all refer to the same type of document—a medical order that provides specific directions about what treatments your parent wants and doesn't want.
Here's the critical difference between a POLST form and other advance planning documents like living wills or advance directives. A living will is a statement of your values and your wishes. It's written in language like "if I'm in a persistent vegetative state, I don't want life support." A POLST form is a doctor's order. It has checkboxes. It says specifically what will and won't be done. It's written in medical language. It carries the weight of a medical order.
This matters because of how medicine works. A living will needs to be interpreted. A doctor needs to read your living will and decide whether the situation you're in matches the situation described in the living will. A POLST form doesn't require interpretation. It's clear. It's checked. It says "no CPR" or "yes CPR" or "CPR only if a sudden event." It says whether the person wants antibiotics for infection or not. It says whether they want artificial nutrition or not. It says whether they want hospitalization or not.
Because it's a medical order, it's more portable than other documents. Your parent can't carry their entire living will and advance directive with them everywhere, but they can have a POLST form. In fact, many states recommend that POLST forms be printed on bright pink or yellow paper so paramedics can see them immediately. A nursing home that admits your parent should check for a POLST form. Hospitals should check for one when your parent is admitted. If your parent is at home and calls 911, paramedics will look for a POLST form.
The POLST form is meant for people who are seriously ill, are near the end of life, or have advanced chronic illness. It's not appropriate for healthy people. A healthy sixty-year-old with no serious health conditions doesn't need a POLST form. A ninety-five-year-old with metastatic cancer and heart failure should probably have one. A person with advanced dementia who's declining should probably have one. The form is for people for whom death in the foreseeable future is realistic.
Your parent's physician completes the POLST form with your parent (if possible) or with you as their decision-maker. The physician evaluates your parent's current health, discusses what treatments make sense given that health status, and documents the choices. The form covers specific domains. It addresses whether your parent wants CPR. It addresses whether your parent wants hospitalization. It addresses whether your parent wants artificial nutrition and hydration. It addresses goals of care.
The POLST form needs to be signed by your parent if they have capacity, and it needs to be signed by the physician. This is what makes it an order. It's not just your parent's wishes. It's the physician's assessment of what's appropriate and what your parent wants. The form then travels with your parent. If your parent moves between care settings, the form moves too. If your parent goes to the hospital, the form should go to the hospital. Paramedics who see the form will follow its directions.
Your parent can revoke the POLST form at any time. If they change their mind, they can ask for a new one to be completed. The most recent form is the one that applies. If your parent says they want CPR now, and there's a POLST form that says no CPR, a new POLST form with CPR can be completed.
Your Parent's Specific Situation
The question of whether your parent needs a POLST form depends on their health status. If your parent is seriously ill or approaching the end of life, the answer is probably yes. If your parent is healthy, the answer is probably no.
Talk with your parent's physician. The doctor is the one who actually completes the POLST form, and they're the one who can assess whether it's appropriate. They should initiate the conversation. Many providers are trained to talk about POLST forms as part of advance care planning conversations. If your parent's doctor hasn't mentioned it and your parent is seriously ill, bring it up.
The conversation about a POLST form is more concrete than the conversation about a general advance directive. With an advance directive, you might talk about values. With a POLST form, you're talking about specific treatments. Does your parent want antibiotics if they get pneumonia? Does your parent want to be admitted to the hospital if they have an acute problem? Does your parent want artificial nutrition if they can't eat? These are specific, medical questions. Some people find these easier to answer than abstract questions about values. Others find them harder because they're so specific.
Your parent should be involved in these decisions if possible. If your parent is alert and can express their wishes, they should be. If your parent has already lost capacity, you'll be making these decisions as their surrogate. If your parent still has capacity but it's declining, this is another conversation to have sooner rather than later.
You also need to understand what documentation your parent already has. Some advance directives include quite specific information about end-of-life treatment. If your parent has a really clear advance directive that addresses these questions, a POLST form might be less critical. But most general advance directives are not as specific as POLST forms, and a POLST form is much more portable and actionable.
Where your parent is living matters too. If your parent is in a nursing home, the nursing home usually has processes for discussing POLST forms and having them completed. If your parent is at home, you might need to work with their physician to get one completed. If your parent is in the hospital, the hospital can initiate the conversation and complete the form before your parent is discharged.
Taking Next Steps
The first step is a conversation with your parent's physician. If your parent is seriously ill or near the end of life, bring it up directly. Say something like, "We've been thinking about my mother's medical values. Should we be talking about a POLST form?" The doctor can assess whether it's appropriate and initiate the conversation.
If your parent is still capable of expressing their wishes, they should be the one talking to the doctor. If your parent has lost capacity, you'll be doing this as their surrogate, and you'll want to make decisions based on what you know about their values. What did your parent say they wanted? What matters to them? A person with advanced dementia who loves being outside and enjoys music might want antibiotics to treat an infection so they can continue to have those experiences. A person with advanced cancer who's in pain might want comfort care only. There's no right answer. There's just your parent's answer.
Once the POLST form is completed and signed, it needs to be distributed. Copies should be posted at your parent's home, in their medical chart, in the nursing home's records if applicable. Your parent should carry a copy if possible. Some states have registries where POLST forms can be registered so that paramedics can look them up.
This is one of those documents where you're not trying to control your parent's medical situation. You're trying to honor what your parent actually wants. You're trying to make sure that when your parent is sick and scared and can't advocate for themselves, their wishes are being followed, not overridden because hospital protocol says to treat the acute problem.
The POLST form works best as part of a comprehensive advance care planning process. You probably also have a power of attorney for healthcare. You might have a living will or advance directive. These documents work together. The POLST form is the actionable piece. It's the piece that tells paramedics what to do when there are seconds to decide. Having it in place for a seriously ill parent is not preparing for their death. It's preparing for their care to actually reflect what they want.
How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you are concerned about a loved one's cognitive health or safety, consult with their healthcare provider or contact your local Area Agency on Aging for guidance and support.