The Physcian Orders for Life Sustaining Treatment (POLST) became effective January 1, 2009.

The POLST form is not a substitute for an Advanced Health Care Directive.

The POLST is a voluntary agreement between a resident and his/her physician regarding end-of-life decisions. A facility or care provider can not require a resident to fill out a POLST form.When a resident chooses to fill out a POLST form, the health care provider is required to explain end-of-life options. The physician is responsible for obtaining the resident's informed consent and assuring that the resident receives all material information that is pertinent ot the resident's decision. Even if health care providers in a skilled nursing facility fill out a POLST form, the form is not valid without the physician-resident discussion that leads to informed consent. (California Department of Public Health All Facilities Letter 09-27, dated August 24, 2009.)

The POLST form:

• is a standardized form that is brightly colored and clearly identifiable;
• can be revoked by any individual or their representative at any time;
• is legally sufficient as a physician order and not an advanced directive;
• is recognized, adopted and honored across treatment settings and
• allows an individual with capacity to, at any time, request alternative treatment to that treatment that was ordered on the form.

The POLST should be revisited on a regular basis to assure the decisions expressed still reflect the resident's wishes. The POLST should be reviewed during each quarterly care plan conference, when there is any change of condition, or when the resident is scheduled for new medical procedures.