NJ POLST Form: When Your Parent Needs Practitioner Orders for Life-Sustaining Treatment

Your parent is being admitted to a nursing facility or transferred from the hospital, and the social worker hands you a bright-colored form titled "POLST." This isn't another optional piece of paperwork — it's a medical order that tells emergency responders and facility staff exactly what interventions to provide or withhold when your parent cannot speak for themselves.

What the NJ POLST Form Actually Is

POLST stands for Practitioner Orders for Life-Sustaining Treatment. Unlike an advance directive (which is a legal document your parent signs independently), a POLST is a medical order signed by a licensed physician, advanced practice nurse, or physician assistant after a clinical conversation with the patient or their authorized healthcare representative.

The POLST translates your parent's treatment preferences into actionable medical orders that:

• Travel with the patient between care settings (hospital, nursing home, home)
• Are immediately honored by EMS, emergency departments, and facility staff
• Override default full-treatment protocols without requiring anyone to locate and interpret a separate legal document

POLST vs. Advance Directive: Different Tools for Different Purposes

Many families confuse these two documents or assume one replaces the other. They serve complementary roles:

Advance Directive (N.J.S.A. 26:2H-53 et seq.):

• Signed by your parent while they have capacity
• Designates a healthcare representative (proxy)
• Records general treatment preferences and values
• Becomes operative only after a clinical determination of incapacity
• Does not constitute a medical order

POLST:

• Completed by a licensed practitioner based on a goals-of-care conversation
• Constitutes an actual medical order, effective immediately
• Covers specific interventions: CPR, intubation, IV antibiotics, artificial nutrition
• Appropriate for patients with serious illness, advanced frailty, or limited life expectancy
• Can be completed with the healthcare representative if the patient lacks capacity

Your parent should have both: the advance directive establishes who makes decisions and what values guide them, while the POLST converts those values into specific medical orders that front-line staff follow without delay.

When a POLST Becomes Necessary

A POLST is clinically appropriate when your parent:

• Has been diagnosed with a serious, life-limiting illness
• Is transitioning to long-term nursing facility care
• Would not be surprised if they did not survive the next 12 months
• Has been hospitalized multiple times in the past year
• Is receiving hospice or palliative care services

The POLST is not intended for healthy older adults doing advance planning — that's what the advance directive covers. The POLST is for patients whose current medical condition makes specific treatment decisions immediately relevant.

What the Form Covers

The NJ POLST form addresses several categories of intervention:

Section A — Cardiopulmonary Resuscitation (CPR): If the patient has no pulse and is not breathing, should EMS attempt CPR? Options are Full CPR or Do Not Attempt Resuscitation (DNAR).

Section B — Medical Interventions: If the patient has a pulse but requires emergency intervention, what level of treatment? Options range from Full Treatment (ICU, intubation, mechanical ventilation) to Comfort-Focused Treatment (symptom management only, no transfer to hospital).

Section C — Artificially Administered Nutrition: Should the patient receive tube feeding or IV nutrition if they cannot eat by mouth? Options include long-term tube feeding, time-limited trial, or no artificial nutrition.

Who Signs the POLST

The practitioner (MD, DO, APN, or PA) must sign after discussing treatment goals with the patient or their authorized decision-maker. If your parent lacks capacity, their healthcare representative designated under an advance directive can participate in this conversation and authorize the POLST.

This is where having a valid advance directive matters: without one, the facility must determine who has legal authority to participate in POLST discussions — which may require court-appointed guardianship if no advance directive names a representative.

Keeping the POLST Accessible

The form must be readily available — posted in the home (typically on the refrigerator), placed in the front of the medical chart at a facility, or carried with the patient during transport. EMS cannot honor orders they cannot find.

Connecting Legal Authority to Medical Orders

The New Jersey Power of Attorney & Guardianship Kit covers both the advance directive (which establishes your authority as healthcare representative) and guidance on how that authority connects to POLST conversations, hospital discharge planning, and facility admission decisions.

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