Hospice and Palliative Care Advance Directives in Maine

When someone transitions to hospice or palliative care, the advance directive becomes the most important document in their file. It's no longer a theoretical planning exercise — it's the operating manual for every comfort-versus-intervention decision the medical team faces.

But most advance directives are written during healthy planning moments, using broad language like "no extraordinary measures." When hospice care begins, that vagueness creates exactly the kind of ambiguity everyone was trying to avoid.

Why Advance Directives Matter More in Hospice

Hospice care in Maine is comfort-focused by definition. The patient has a terminal diagnosis with a life expectancy of six months or less, and the goal shifts from curing the disease to managing symptoms and quality of life.

That shift creates dozens of specific medical decisions that a generic advance directive may not address:

• Should pain medication be increased even if it causes sedation or shortens remaining time?
• If the patient develops pneumonia, should antibiotics be administered or is this a natural part of the dying process?
• Should IV fluids be started if the patient stops eating and drinking?
• If the patient's heart stops, should CPR be attempted? (Hospice patients almost never benefit from CPR, but without clear documentation, the default is to try.)

Your advance directive's individual instructions (Part 2) should speak directly to these scenarios. The more specific your preferences, the less your healthcare agent has to guess during emotional, time-pressured moments.

Coordinating with POLST Forms

Most hospice patients in Maine should have both an advance directive and a POLST (Provider Orders for Life-Sustaining Treatment) form. These documents serve different but complementary purposes:

The advance directive is your long-term planning document. It designates your healthcare agent and documents your treatment philosophy. It's a legal instrument signed by you and two witnesses.

The POLST is a medical order signed by your physician. It translates your preferences into specific, actionable clinical orders that follow you across every care setting — home, ambulance, hospital, hospice facility.

Section A of the POLST determines CPR status. If "No CPR" is checked, EMS personnel will not attempt resuscitation. Section B covers broader medical interventions, from full treatment down to comfort-focused measures only. Section C addresses artificial nutrition and hydration.

For hospice patients, the POLST typically reflects comfort-focused treatment across all sections. But it must be discussed with and signed by the attending physician — you can't fill it out yourself.

What to Update When Entering Hospice

If you have an existing advance directive, review it when hospice care begins. Ask yourself:

Are the instructions specific enough? "No life-prolonging measures" is a starting point, but hospice teams deal with granular decisions daily. Consider adding explicit instructions about pain management priorities, antibiotic use for comfort versus cure, IV hydration, and hospital transfers.

Is your healthcare agent still the right person? Hospice can last weeks or months. Your agent needs to be available, emotionally equipped, and geographically reachable. If your original agent lives out of state, consider whether your alternate agent or someone local should take the primary role.

Does your POLST match your directive? If your advance directive says "comfort measures only" but you don't have a POLST, first responders will still perform CPR if someone calls 911. Get a POLST from your hospice physician.

Palliative Care vs. Hospice

Palliative care and hospice are related but different. Palliative care can begin at any stage of illness — you don't need a terminal diagnosis or a six-month prognosis. It focuses on symptom management alongside curative treatment.

For palliative care patients, the advance directive is still critical because the disease may progress to a point where hospice becomes appropriate. Having your preferences documented early means the transition is smooth rather than scrambled.

The Maine Advance Directive & Living Will Kit includes specific treatment-preference prompts designed for hospice and palliative care scenarios, plus guidance on coordinating your directive with a POLST form.

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