California clinicians who work with seriously ill and frail older adults will want to take note of an important update to the state’s POLST laws. On September 27, Governor Gavin Newsom signed SB 1088 (Blakespear) into law. This legislation, sponsored by the Coalition for Compassionate Care of California (CCCC), modernizes and clarifies California statutes governing POLST and the pre-hospital Do Not Resuscitate (DNR) form. The changes take effect January 1, 2027. SB 1088 pretty much sailed through its legislative trajectory, with zero “no” votes in any committee or in the full Senate and Assembly, and it was thankfully not felt to be controversial–but rather more of a cleanup bill to bring POLST up to date.

For those of us practicing in post-acute and long-term care, several provisions are particularly noteworthy.
First, although the familiar acronym remains, the name will change from “Physician Orders for Life-Sustaining Treatment” to “POLST (Portable Orders Listing Scope of Treatment).” This reflects both the broader purpose of POLST and the reality that qualified nurse practitioners and physician assistants/associates, not just physicians, can sign these medical orders (since 2016). SB 1088 also authorizes NPs and PAs to sign California’s prehospital DNR form, which they were not previously permitted to do. Although this form has been utilized much less frequently since POLST was introduced in California in 2009, it is still available and a legal option for those wishing to avoid CPR.

The legislation also provides welcome clarification regarding who may sign a POLST for a patient who lacks decision-making capacity. Authorized decision-makers include an appointed health care agent, an appropriately authorized guardian or conservator, a legally recognized surrogate, or, in applicable skilled nursing facility circumstances (with unrepresented incapacitated residents), the interdisciplinary team process with patient representation specified under California law. Importantly, simply being a patient’s “next of kin” does not by itself confer authority to sign a POLST.

Another significant provision makes explicit something that should already be central to good POLST practice: POLST is always voluntary. A patient cannot be required to complete a POLST or prehospital DNR as a condition of admission to a facility or as a condition of receiving health care or other services. This is particularly relevant in PALTC, where a POLST can sometimes inadvertently become perceived as just another required admission document rather than the product of an individualized goals-of-care conversation.

SB 1088 also explicitly recognizes electronic signatures on POLST, an important step as California moves toward greater use of electronic health records and a statewide POLST electronic registry. In addition, valid POLST or comparable medical-order forms and prehospital DNR forms completed in other states will be recognized in California, helping preserve continuity of patients’ treatment preferences when they travel or relocate.

These changes grew in part out of a 2024 statewide survey conducted by CCCC and shared with the California Emergency Medical Services Authority (EMSA), the agency that administers POLST. This survey identified numerous and substantial gaps in clinician understanding of POLST and its relationship to other advance-care-planning tools. CCCC and EMSA are now working on revisions to the California POLST form required by the new law, along with implementation of a statewide POLST registry.

Want to learn more? CCCC members can participate in its upcoming Public Policy Update, which will include discussion of SB 1088 and anticipated changes to the POLST form. Visit the CCCC education and events page for upcoming webinar information.

CCCC will also hold its 2026 Summit: Foundations and Futures, October 15–16 in San Jose, featuring education and discussion on palliative care, serious illness, advance care planning and related issues. Learn more and register for the CCCC Summit. I hope to see some of you there!

For additional detail about SB 1088 and the forthcoming POLST changes, visit CCCC’s legislative policy page.

Karl Steinberg, MD, CMD, HMDC, HEC-C, FPALTC
Vice President and Past President, CALTCM
Secretary, Coalition for Compassionate Care of California