Alaska Hospice Planning: Documents You Need Before Starting Care

When an Alaska family decides to pursue hospice care, the clinical focus shifts from treatment to comfort. But that shift creates immediate paperwork requirements — hospice agencies must document your preferences on resuscitation, life support, and emergency intervention before care begins. In rural Alaska, where the nearest hospice provider may serve a region the size of a small European country, getting those documents in order before the first visit avoids delays that can cost families days of unnecessary suffering.

What Hospice Agencies Require

Every hospice provider in Alaska will ask for:

1. An advance health care directive — your healthcare agent designation and treatment preferences under AS 13.52
2. A POLST or DNR order — a clinician-signed medical order that tells EMS exactly what to do (and not do) during an emergency
3. HIPAA authorization — so the hospice team can share your information with your family and coordinate care across providers

Without these documents, the hospice agency can still admit you, but they'll need to establish your preferences through clinical conversations — adding days to the intake process and creating risk that an emergency will force default aggressive treatment before your wishes are documented.

The POLST Conversation

Hospice eligibility generally means you have a terminal or advanced illness — exactly the population POLST was designed for. Your hospice physician, PA, or APRN (all authorized to sign POLST orders in Alaska since November 2022) will want to complete a POLST that covers:

• Resuscitation: Attempt CPR or allow natural death
• Medical interventions: Full treatment, limited intervention, or comfort-focused only
• Artificially administered nutrition: Long-term tube feeding, trial period, or no artificial nutrition

Having a completed advance directive before this conversation makes the POLST process faster and more accurate. Your clinician can reference your stated treatment preferences rather than rebuilding them from scratch.

Coordinating Documents in Rural Alaska

For families in bush communities, hospice care often involves providers based in regional hubs — Bethel, Nome, Fairbanks — managing care remotely through village health aides and telehealth. Document access becomes critical:

Scan into the tribal EHR. If you receive care through a tribal health organization, get your advance directive and POLST scanned into the designated folder on your EHR summary page. This ensures every provider in the network — from the village clinic to the specialty team in Anchorage — can see your current preferences.

File with the hospice agency directly. Send copies to the hospice provider's central office and to any field staff assigned to your case.

Notify local EMS. If your POLST includes a DNR order, fax it with a HIPAA-compliant coversheet to your local dispatch center. This prevents a well-meaning neighbor from calling 911 and triggering aggressive resuscitation that contradicts your wishes.

When a Comfort One Card Still Works

If your family member has an old Comfort One form or bracelet signed before June 2022, it's still legally valid. EMS must honor it. But if you're entering hospice and establishing a comprehensive care plan, completing a current POLST is strongly recommended — it covers more clinical parameters than the binary DNR of Comfort One, and being the most recently signed document means it controls under Alaska's recency rule.

Revoking or Updating During Hospice

Hospice isn't irreversible. If the patient's condition changes or they want to pursue curative treatment again, both the advance directive and POLST can be updated. The advance directive can be revoked at any time while the patient retains capacity. The POLST is updated through a new conversation with the signing clinician.

The Alaska Advance Directive & Living Will Kit helps families prepare the foundational documents hospice agencies require, with step-by-step instructions for each section and a distribution checklist built for Alaska's rural healthcare infrastructure.

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