Secure Your California DNR With Smart Estate Planning
{
“blog_title”: “Secure Your California DNR With Smart Estate Planning”,
“blog_content”: “
Secure Your California DNR With Smart Estate Planning
Why Your Estate Plan Should Address a DNR
A California DNR is a medical order that tells health care professionals not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing. Because emergencies often unfold outside the presence of family or your attorney-in-fact, integrating a DNR into your broader estate plan helps ensure first responders and providers have clear, actionable instructions that align with your values. See California EMSA guidance on end-of-life decisions for EMS personnel (EMSA Chap. 2).
DNR vs. Advance Health Care Directive vs. POLST
- DNR: A medical order directing no CPR. For EMS recognition, California’s standardized Out-of-Hospital DNR form requires a physician’s signature. In practice, a POLST can also serve as a DNR order when it records “Do Not Resuscitate” (EMSA Chap. 2).
- Advance Health Care Directive (AHCD): A legal document where you name an agent and state your treatment preferences. It guides decision-making but is not itself a medical order for emergency personnel (CA OAG on AHCD).
- POLST: A set of portable medical orders covering CPR and other treatments (such as hospitalization, ventilation, and artificial nutrition). It is intended for individuals with serious illness or frailty and travels with you across care settings. In California, a POLST may be signed by a physician, nurse practitioner, or physician assistant (EMSA POLST).
These tools complement each other: your AHCD expresses preferences and appoints an agent; your DNR or POLST converts those preferences into actionable medical orders for clinicians and EMS.
The California Out-of-Hospital DNR and EMS
California recognizes an Out-of-Hospital DNR that instructs emergency medical services not to provide CPR in the field or during transport. EMS responders look for standardized DNR documentation, an approved DNR medallion/bracelet, or a POLST reflecting “Do Not Resuscitate.” If no valid order is found or its validity is uncertain, EMS will typically initiate resuscitation (EMSA Chap. 2).
POLST: Broader Orders That Travel With You
For many clients, a POLST provides more comprehensive guidance than a standalone DNR. It documents choices about CPR and additional interventions and is designed to be honored across settings—including home, assisted living, nursing facilities, and hospitals. A POLST should be discussed with your clinician and signed by both you (or your legally recognized decision-maker) and your treating professional (EMSA POLST).
Making Your DNR Effective and Available
- Discuss with your clinician: Your physician can issue an Out-of-Hospital DNR; your physician, nurse practitioner, or physician assistant can complete a POLST reflecting your goals of care (EMSA POLST; EMSA Chap. 2).
- Coordinate with your AHCD: Ensure your agent’s authority and your stated preferences align with any medical orders. Share copies with your agent and key family members (CA OAG on AHCD).
- Keep it visible: Store originals in an accessible location at home. Consider wallet cards, approved medallions/bracelets, or forms posted where EMS can quickly find them (EMSA Chap. 2).
- Share across providers: Give copies to your primary care clinician, specialists, home health, hospice, assisted living or nursing facility, and hospital patient portals where available.
- Review after changes: Revisit your choices after major health events, changes in residence or care settings, or updates to your medical condition.
Special Considerations in Hospitals and Facilities
Hospitals and licensed facilities have policies for confirming and honoring DNR and POLST orders. On admission, bring your documents so staff can enter them into the medical record. If you arrive without documents, clinicians may reconfirm your wishes and write new orders consistent with your preferences and capacity.
Common Misunderstandings
- A DNR does not stop all treatment. You can still receive comfort care, medications, oxygen, and other supportive measures.
- An AHCD alone is not a DNR. Without a medical order like a DNR or POLST, EMS will generally begin resuscitation (EMSA Chap. 2).
- Wearable identifiers. Approved DNR medallions/bracelets can be used; ensure the underlying medical order is current and accessible (EMSA Chap. 2).
Practical Tips
- Use a brightly colored folder labeled DNR/POLST near your refrigerator or bedside where EMS typically looks.
- Add your agent and clinician to your phone’s Medical ID and share copies via your patient portal.
- Consider an approved DNR bracelet to reduce confusion during emergencies.
Checklist: Integrate DNR Into Your Estate Plan
- Complete or update your Advance Health Care Directive and HIPAA release.
- Discuss goals of care with your clinician; complete a POLST if appropriate.
- Obtain a physician-signed Out-of-Hospital DNR if you want no CPR.
- Ensure AHCD, DNR, and POLST are consistent and list the same agent.
- Distribute copies to your agent, family, and all care providers.
- Store originals in an obvious, accessible place; consider a bracelet.
- Upload to hospital portals and carry a wallet card.
- Review after any major health or residence change.
FAQ
Does my AHCD replace a DNR?
No. An AHCD expresses preferences and names an agent but is not a medical order for EMS. A DNR or POLST provides actionable orders.
Who can sign a POLST in California?
A physician, nurse practitioner, or physician assistant may sign. Your signature (or your legally recognized decision-maker’s) is also required.
Will a hospital honor my out-of-hospital DNR?
Hospitals will confirm your wishes and enter appropriate orders. Bring your documents; if unavailable, clinicians may write new orders consistent with your preferences and capacity.
Can I still get comfort care with a DNR?
Yes. A DNR limits CPR only. Comfort-focused treatments, medications, oxygen, and other measures can still be provided.
How Our Firm Can Help
We coordinate with your medical team to align your Advance Health Care Directive with a California DNR or POLST, ensure your agent’s authority is clear, provide practical guidance for storing and sharing documents, and update your plan as your circumstances change. Ready to protect your wishes? Contact us.
Sources
- California Emergency Medical Services Authority — DNR/POLST policies (EMSA Chap. 2)
- California Emergency Medical Services Authority — POLST information
- California Office of the Attorney General — Advance Health Care Directive
Disclaimer
This blog is for general informational purposes only and is not legal or medical advice. Reading it does not create an attorney–client relationship. Laws and policies can change and may vary by county, provider, or facility. Consult a licensed California attorney and your health care professional for advice about your specific situation.
“,
“blog_excerpt”: “How California DNR and POLST orders work with your Advance Health Care Directive, and the steps to make sure EMS and providers honor your wishes across care settings.”,
“blog_keyword”: [“California DNR”, “POLST”, “Advance Health Care Directive”, “estate planning”, “end-of-life planning”, “EMS”, “health care proxy”, “HIPAA release”],
“blog_category”: [“Estate Planning”, “Elder Law”, “Health Care Directives”, “California Law”],
“blog_type”: “blog”
}[/P]
- Preserve documents, photos, and communications immediately.
- Avoid recorded statements to insurers without counsel.
- Track expenses, lost income, and impacts as they occur.