How often do Advance Directives need to be reviewed?




It is considered best practice to review the resident’s Advance Directives with the resident and resident representative upon admission, in each Care Plan meeting, and with any significant change in the resident’s status. This will ensure that the facility team and resident/representative are kept aware of the current Advance Directives in the record and are provided an opportunity to change/revoke these if legally able to do so.

It is also important to remember that the majority of states that utilize the MOST/MOLST/or POLST forms for Advance Directives require these to be reviewed “periodically” or yearly, with some requiring review signatures each year, or at set time frames. For example, some forms have the following or similar instructions:

This MOST must be reviewed at least annually or earlier if:

      • The patient is admitted and/or discharged from a health care facility;
      • There is a substantial change in the patient’s health status; or
      • The patient’s treatment preferences change.
      • If MOST is revised or becomes invalid, draw a line through sections A – E and write “VOID” in large letters

It is important to know the requirements for the Advance Directive forms that are used in your state, and to track and comply with annual reviews if required.


Janine Lehman, RN, RAC-CT, CLNC
Director of Legal Nurse Consulting

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