Families often describe POLST as “the form that tells everyone what we want.” That’s close, but it’s not specific enough to be useful. The reason POLST matters is not that it expresses preferences. Lots of documents do that. POLST matters because it translates preferences into medical orders—instructions clinicians and emergency responders can act on immediately when someone can’t speak and time is short.
This article explains what POLST is, why it is fundamentally different from a living will, and how families use it to prevent unwanted emergency interventions. This is educational and not medical or legal advice. POLST names vary by state (MOLST, MOST, POST, etc.), and your clinician should guide you on which form applies where you live.
What POLST Is, in the Words of the Programs That Use It
The National POLST program describes POLST forms as out-of-hospital medical orders that travel with you and tell health care providers what treatments you want and your goals of care, even as you move from hospital to nursing home, to home, to hospice, and across settings.
If you want an even simpler definition, National POLST’s patient-facing explanation says POLST forms are medical order forms that tell medical staff what to do if you have a medical emergency and are unable to speak for yourself.
The key phrase is “medical order.” A preference becomes a medical order only when it is discussed with a clinician and signed appropriately. That is why POLST is completed with a health care professional, not in isolation at a kitchen table.
Why POLST Was Created: The Gap Between Wishes and Emergencies
Many families have experienced this gap. A person says, “I don’t want to be kept alive on machines,” but when a crisis hits, emergency responders arrive and do what they are trained to do: resuscitate, transport, stabilize. If there is no clear, actionable order available in that moment, care often defaults to aggressive intervention—even when the family is certain the person would not want it.
POLST was created to close that gap for people who are seriously ill or frail. It’s meant to prevent the scenario where a person’s wishes exist only as a conversation or a document nobody can find in time.
What POLST Usually Covers
Although forms vary by state, POLST usually focuses on a small set of emergency decisions that commonly arise in serious illness:
- Whether to attempt CPR if the person has no pulse and isn’t breathing
- What level of medical intervention is desired if the person still has a pulse or is breathing (for example: comfort-focused care versus limited interventions versus full treatment)
- Whether to transfer to the hospital in certain situations
- Whether medically assisted nutrition (feeding tubes) should be used, in some versions
National POLST explains this sequence clearly in its patient guidance: if someone isn’t breathing and has no pulse, the critical question is whether they want CPR. If they are breathing or have a pulse, the next question is what treatments they want and whether they want to go to the hospital.
Why POLST Is Not an Advance Directive
Families sometimes ask, “If we have a living will, why do we need POLST?” Because a living will is not a portable emergency order, and it usually isn’t written in the format emergency medical teams rely on in seconds.
The National Institute on Aging describes advance directives as legal documents that provide instructions for medical care and only go into effect if you cannot communicate. NIA also notes that POLST forms provide guidance that health care professionals can act on immediately in an emergency and serve as a medical order in addition to an advance directive.
CaringInfo adds a practical distinction families often miss: advance directives appoint someone to speak for you, while POLST is a set of medical orders for a limited population, and it can specify things a DNR alone does not (like treatment levels and sometimes feeding tubes).Why POLST Is Typically for the “Seriously Ill or Frail”
POLST medical orders are powerful, which is why they’re intended for a more specific population. National POLST emphasizes that POLST is for people who are “seriously ill or frail” and that it gives more specific direction over treatments than advance directives.
Healthy people’s preferences can change as their health changes. POLST is meant for situations where the medical context is clearer—where the question isn’t “What would I want someday?” but “Given this illness and this likely trajectory, what do I want if a crisis happens?”
How POLST Becomes “Real”
Because POLST is a medical order, the process matters. It typically involves a conversation with a clinician about goals and likely outcomes, then documenting orders clearly, then ensuring the form is signed, dated, and stored in a way that travels with the patient.
National POLST’s model form and instructions emphasize that a copied, faxed, or electronic version can be a legal and valid medical order and that the form does not expire, but that it should be reviewed when the medical condition changes.
That review point is important. POLST is not meant to freeze decisions forever. It is meant to make decisions actionable right now, with review as health evolves.
What Families Can Do to Make POLST Work in the Real World
Most POLST problems are not philosophical problems. They’re visibility problems. The form exists, but EMS can’t find it, or it doesn’t travel with the patient, or a facility files it somewhere nobody checks.
National POLST emphasizes portability across settings. National POLST In practical terms, that means families often ask these questions:
- Where should the POLST be kept at home so EMS can find it quickly?
- How will the nursing home or hospital store it so it stays with the patient through transfers?
- Who has copies, and how do we prevent old versions from floating around?
If your family is building a broader “make it findable” system for medical documents, Funeral.com’s guide Important Papers to Organize Before and After a Death can help you create a usable folder structure for real life.
How POLST Fits With Hospice and Comfort-Focused Care
POLST conversations often happen alongside hospice conversations, because hospice is also a goals-of-care shift. Medicare explains that hospice involves accepting comfort care instead of care to cure the illness and choosing hospice care instead of other Medicare-covered treatments for the terminal illness and related conditions.
In hospice, POLST can function as the emergency translation of hospice goals—especially when the patient wants to avoid resuscitation or wants comfort-focused treatment rather than hospital transfer in certain crises. If your family needs a hospice overview that sets expectations clearly, start with Home Hospice: What It Is, What It Covers, and How to Prepare.
A Gentle Closing
The simplest way to think about POLST is this: it’s not a statement of preference; it’s a way to turn preferences into medical orders that can be followed in emergencies across settings. That is what National POLST means when it calls POLST “out-of-hospital medical orders” that travel with you.
If your family wants clarity, start with values and an advance directive, then ask your clinician whether POLST is appropriate for the current medical situation. When POLST is used for the right person at the right time, it can prevent unwanted interventions and reduce a uniquely painful kind of family regret: knowing what someone wanted, but not being able to make it happen in the moment that mattered most.
SEO Meta Description: POLST explained in plain English—why it’s a portable medical order (not just a preference), who it’s for, what it typically covers (CPR, treatment levels, hospital transfer, feeding tubes), and how families make POLST usable across home, hospital, nursing home, and hospice.
