advance care planning, POLST, provider orders for life-sustaining treatment, respecting choices



  1. Hall, Nancy A. DNP, RN
  2. Jenson, Carole E. DNP, RN, ACNS-BC, CCRN


Increasing numbers of older Americans with chronic, life-limiting illness are residing in assisted living facilities. Advance care planning can provide for care at the end of life consistent with patient preferences. The purpose of this project was to implement the Respecting Choices model of Provider Orders for Life-Sustaining Treatment (POLST)-type advance care planning in an assisted living facility. POLST-type advance care planning results in a document that communicates care preferences as a provider's order, actionable in local health care settings. Eight residents and their health care agents participated in POLST-type advance care planning; POLST documents were signed by the physician. Follow-up review of the assisted living medical records indicated that residents who experienced POLST-type advance care planning had more provider orders addressing life-sustaining treatments than were previously present. Ninety-four percent of participants who completed a satisfaction survey rated the overall quality of the discussion as excellent. In the context of a community-wide effort, POLST-type advance care planning was successfully implemented with appropriate residents in an assisted living facility, providing for clearly documented orders to inform end-of-life care consistent with residents' preferences.