Advance Directives and POLST in New Jersey: A Family Guide

By the care managers at Connections Care Management · Updated November 2026

What is an advance directive in New Jersey?

An advance directive is a written document that tells doctors and family what your parent wants if they cannot speak for themselves. New Jersey law recognizes three forms:

• Proxy directive. Names a health care representative, the person who will make medical decisions if your parent loses the ability to decide. In other states this is often called a health care proxy or medical power of attorney.
• Instruction directive. Often called a living will. It describes the kinds of treatment your parent would or would not want in situations such as terminal illness, permanent unconsciousness or advanced dementia.
• Combined directive. Both in one document, which many people choose.

Generally, a New Jersey advance directive must be in writing, signed and dated, and either witnessed by two adults or acknowledged before a notary, attorney or other authorized officer. The person named as health care representative should not serve as a witness. Requirements can change, so confirm the details with an elder law attorney or use the state's official form. We are care managers, not attorneys, and this guide is general information, not legal advice.

What is a POLST form?

POLST stands for Practitioner Orders for Life-Sustaining Treatment. In New Jersey it is a medical order, signed by your parent (or their representative) and by a physician, advanced practice nurse or physician assistant. It records decisions about treatments such as CPR, breathing machines, hospital transfer and artificial nutrition.

Key points:

• It is meant for people with serious illness or frailty, not healthy adults.
• It is a set of medical orders that health care staff, including emergency responders, are meant to follow.
• It travels with your parent from one setting to another: home, hospital, nursing home or hospice.
• It is voluntary. No one should be required to complete one.
• It can be changed as health or wishes change.

What is the difference between an advance directive and a POLST?

• Who it is for. Advance directive: any adult. POLST: someone with serious illness or advanced frailty.
• Who signs. Advance directive: your parent, with witnesses or a notary. POLST: your parent or representative, plus a clinician.
• What it is. Advance directive: a legal document stating wishes and naming a decision maker. POLST: medical orders about specific treatments now.
• When it applies. Advance directive: when your parent cannot make decisions. POLST: right away, in the current state of health.
• Does it name a decision maker? Advance directive: yes (proxy). POLST: no. It does not replace a health care representative.

Many seriously ill older adults have both. The advance directive names who decides and describes values. The POLST turns current wishes into orders that emergency staff can act on.

Who should my parent name as health care representative?

The best choice is not always the oldest child or the closest relative. Look for someone who:

• Knows your parent's values and will honor them, even if they would choose differently.
• Can stay calm and think clearly in a hospital.
• Is willing to ask hard questions of doctors.
• Is reachable quickly, ideally nearby.
• Gets along well enough with the rest of the family to keep them informed.

Naming an alternate is wise in case the first choice is unavailable. Your parent should talk with the people they name so no one is surprised.

What if my parent has no advance directive?

If your parent cannot make decisions and has no proxy directive, doctors usually turn to family, but this can lead to confusion and conflict, especially when siblings disagree. In some cases, a court-appointed guardian may be needed. Completing an advance directive while your parent can still do so is far easier. If capacity is already in question, talk with an elder law attorney. See power of attorney and guardianship in NJ.

How do I start the conversation with my parent?

These talks go better when they are framed as part of normal planning, not as a reaction to bad news. Some openers that work:

• "I just did my own health care proxy, and it made me think. Have you ever written down what you'd want?"
• "If you were very sick and couldn't talk, who would you want speaking for you?"
• "What does a good day look like for you? What would make life not worth living?"
• "Is there anything you'd never want done, like being on a breathing machine for a long time?"
• "Grandpa's last months were hard. What would you want to be different for you?"

You do not need to finish in one conversation. It often takes several.

What questions should my parent think about?

• What matters most: living as long as possible, staying comfortable, being at home, being aware?
• How do they feel about CPR, breathing machines, feeding tubes and dialysis?
• Would they want to go to the hospital, or be treated at home or in the nursing home if possible?
• Would they want a trial of treatment, with a plan to stop if it is not helping?
• Do they have religious or cultural beliefs that should guide decisions?
• Where would they want to be at the end of life?

Their doctor is an important part of this conversation, especially for a POLST. Ask for an appointment focused on advance care planning.

Where should copies be kept?

• With your parent, somewhere easy to find (not a safe deposit box).
• With the health care representative and alternate.
• With the primary care doctor and key specialists, so it is in the medical record.
• With the hospital your parent usually uses.
• With the assisted living or nursing home, if your parent lives in one.
• A POLST form is commonly kept somewhere visible at home, such as on the refrigerator, so emergency responders can find it.

When should the documents be reviewed?

A good rule is to look again after any of the "five Ds": a new decade of life, a death in the family, a divorce, a new diagnosis, or a significant decline in health. And review the POLST whenever your parent moves between care settings or their condition changes.

What if family members disagree with my parent's wishes?

This happens more than people expect. A son may want every treatment tried while his mother has said clearly she wants comfort only. The health care representative's job is to speak for what your parent would want, not what the family wants. A written instruction directive helps a great deal here, because it takes some of the weight off the representative. It also helps to hold a family conversation while your parent can still take part, so everyone hears the wishes directly. Our guide to holding a family meeting can help you plan it.

What if my parent lives in Rockland County, NY?

New York uses different forms and terms, such as the health care proxy and the MOLST (Medical Orders for Life-Sustaining Treatment). If your parent lives in or moves between New Jersey and New York, ask an attorney licensed in the right state which documents are needed.

How does Connections Care Management help?

We are not attorneys and do not draft legal documents. We help families have the conversations that make the documents meaningful, and we make sure the wishes are known and followed.

• As part of care planning, we help your parent think through and talk about their values and wishes, and we facilitate family conversations.
• Through medical advocacy, we help make sure doctors and hospitals have the documents and respect them.
• We work alongside your family's elder law attorney so the documents reflect the conversations, and so everyone has copies.

We serve northern New Jersey and Rockland County, NY. Contact us for a free first conversation. If your parent's illness is advanced, see end-of-life planning and hospice in NJ.