RNCohortJournal of the American Medical Directors Association2026

State POLST Program Maturity Status and Dying in the Nursing Home or Hospice in the United States: An Event Time Study.

Komal Patel Murali, May Hua, Patricia W Stone and 2 others

PMID 41720152

WHAT IT FOUND

Nursing home residents were more likely to die in the nursing home or hospice after state POLST programs developed.

Five years after development, it was 5.6 percentage points higher than the year before development. Formal endorsement alone did not show a clear change.

Key findings

01Five years after a state POLST program was developed, the probability of nursing home residents dying in the nursing home or hospice was 5.6 percentage points higher than in the year before development.

02Five years after formal POLST endorsement, dying in the nursing home or hospice was about 2.4 percentage points higher than expected, but this was not statistically significant.

03In the years before POLST development, the probability of dying in place did not differ significantly from the year immediately before development.

STILL TO COME

How it was doneWhat they foundWhat it means for RNs

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What it does not show

The study found associations and trends, not proof that POLST caused residents to die in place. The researchers could not identify the exact mechanisms behind the findings. Other factors happening around POLST development or endorsement could have influenced death location. The study included only nursing home residents, not people living in the community with serious illness. The sample was mostly White, so results may not apply equally to Black and Hispanic residents. POLST programs varied in implementation, and formal endorsement may not reflect actual use in facilities.

Declared interests

The authors declared no conflicts of interest.

The easy way to misread this

Do not conclude that POLST programs cause residents to die in the nursing home or hospice. The study is observational, and the endorsement result was not statistically significant.

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