Advance Directive or POST Form? What Nashville Families Need Signed Before the Crisis

The call always comes before the paperwork is ready

Almost every family we work with in Davidson, Williamson, Rutherford, Wilson and Sumner counties tells a version of the same story. Mom was managing. Then there was a fall, or a stroke, or a urinary tract infection that turned into confusion overnight. Now she is in a hospital bed, she cannot answer questions reliably, and someone in scrubs is asking an adult child what she would have wanted.

At that moment, nobody wants to learn that the folder in the filing cabinet at home contains the wrong document, an unsigned document, or nothing at all. The good news is that Tennessee makes the core paperwork free, short, and available without a lawyer. The catch is that the state uses two separate documents for two separate jobs, and most families only know about one of them.

Two documents, two jobs — and they are not interchangeable

The first is an advance directive. Under the Tennessee Health Care Decisions Act (Tennessee Code Annotated Title 68, Chapter 11, Part 18), a competent adult can record treatment preferences and, more importantly, name a health care agent to speak for them if they lose capacity. The Tennessee Department of Health publishes two plain-language forms for this: an Advance Care Plan, which does both jobs at once, and a shorter Appointment of Health Care Agent form for people who only want to name a decision-maker without writing out treatment preferences.

An advance directive is a statement of your wishes. It is directed at your family and your future care team. It does not, by itself, tell a paramedic standing in a Hendersonville living room at 3 a.m. what to do.

The second document is the POST form — Physician Orders for Scope of Treatment, authorized by Tennessee Code Annotated section 68-11-224. A POST is not a wish. It is a medical order, signed by a physician, physician assistant, nurse practitioner, or clinical nurse specialist after a conversation with the patient or the patient's representative. It states whether CPR should be attempted in the event of cardiac or respiratory arrest, and it also addresses other interventions — the intensity of medical treatment, whether to transfer to a hospital, and how to handle artificially administered nutrition.

The practical distinction: an advance directive is for someday. A POST is for right now, and it is actionable by EMS and by facility staff on sight.

Why the POST form matters in an assisted living community

Tennessee assisted living facilities are licensed by the Tennessee Department of Health Board for Licensing Health Care Facilities under Rule 1200-08-25, and nursing homes under Rule 1200-08-06. Neither an ACLF nor a skilled nursing facility can quietly honor a family's verbal account of what Dad said last Thanksgiving. Staff need an order in the chart.

A properly completed POST is designed to travel. It is valid across Tennessee health care facilities, and it is meant to follow the resident from home to the ambulance to the emergency department to the rehab floor and back. That portability is the whole point — it is what prevents a resident with a clearly documented do-not-resuscitate decision from being intubated during a transfer simply because the receiving hospital had no paperwork.

A POST remains valid until it is revoked. It is not permanent and it is not a trap. A resident with capacity, or their authorized representative, can change or void it at any time, and it should be revisited whenever the medical picture changes meaningfully — after a hospitalization, after a dementia diagnosis progresses, or when a resident moves from assisted living into skilled nursing.

If nobody is named, Tennessee will name somebody

This is the part families underestimate. Tennessee does not leave a patient without a decision-maker. Under Tennessee Code Annotated section 68-11-1806, if a patient lacks capacity, has no health care agent, has no designated surrogate, and has no court-appointed conservator — or if the person who holds that role is not reasonably available — the supervising health care provider identifies a surrogate and documents that choice in the clinical record.

That surrogate is then required to decide according to the patient's known instructions and wishes, and where those are unknown, according to the patient's best interest as the surrogate understands it, taking the patient's personal values into account.

Read that again, because it is the argument for filling out the form. If you do nothing, a decision still gets made — by a person a hospital selects, under a standard that depends entirely on how well that person happens to know your parent. In a blended family, in a family where one adult child lives in Franklin and three live out of state, or in a family that quietly disagrees about aggressive treatment, that is a recipe for conflict at the bedside. Naming an agent in advance settles it.

Note also that a surrogate designation under Tennessee law can be made orally to the supervising provider. That is useful in an emergency, but it is a stopgap, not a plan.

What to actually do this month

Start with the two Department of Health forms. They are free, they are written for ordinary readers, and Tennessee does not require an attorney to complete them. Sign the Advance Care Plan or the Appointment of Health Care Agent, name a primary agent and at least one alternate, and follow the signing and witnessing instructions printed on the form itself.

Then raise the POST form separately, with the physician who actually knows the patient — the primary care doctor, the geriatrician, or the hospitalist during a discharge planning conversation at Vanderbilt, TriStar Centennial, Ascension Saint Thomas or Williamson Medical Center. A POST conversation is a clinical conversation, not a paperwork errand, and it goes better when it happens at a scheduled visit rather than in a crisis.

Make copies and put them where they will be found. One on the refrigerator or in a clearly marked envelope by the front door for EMS, one in the resident's chart at the assisted living community, one with the named agent, one with the primary care practice. A perfectly executed directive locked in a safe deposit box in Green Hills is a document that will not be read in time.

Finally, keep the health care documents separate in your mind from financial and legal authority. A health care agent cannot pay bills, sign an admission agreement's financial terms, or manage a TennCare CHOICES application. Those require a durable financial power of attorney — or, if capacity is already gone, a conservatorship petition in chancery or probate court. Health care forms you can do yourself; the financial and court side is where a Middle Tennessee elder law attorney earns their fee.

For free help sorting out what your family needs, the Greater Nashville Regional Council Area Agency on Aging and Disability can be reached at 615-862-8828. This article is general information about Tennessee law and health care documents, not legal or medical advice for your situation.

Frequently Asked Questions

Does a Tennessee advance directive tell paramedics not to perform CPR?

No. An advance directive records your wishes and names your health care agent, but it is not a medical order and EMS cannot act on it as one. The document that directs whether resuscitation is attempted is the POST form, signed by a physician, physician assistant, nurse practitioner, or clinical nurse specialist under Tennessee Code Annotated section 68-11-224. Families who want a do-not-resuscitate decision honored outside a hospital need the POST, not just the directive.

Do I need a lawyer to complete a Tennessee advance directive?

Not for the health care forms. The Tennessee Department of Health publishes an Advance Care Plan and an Appointment of Health Care Agent form that an adult with capacity can complete without an attorney, following the signing and witnessing instructions on the form. You should involve an elder law attorney for the financial side — a durable financial power of attorney, trust planning, TennCare CHOICES asset questions, or a conservatorship petition if capacity has already been lost.

Will a Nashville assisted living community accept a POST form signed somewhere else?

Generally yes. A properly completed POST is intended to be valid across Tennessee health care facilities and to travel with the patient between settings. Give the community a copy at move-in so it goes into the chart, and ask the director of nursing to confirm it has been filed and flagged. Also plan to revisit it after any hospitalization or significant change in condition.

What happens if my parent loses capacity before anything is signed?

Tennessee still produces a decision-maker. Under Tennessee Code Annotated section 68-11-1806, when a patient lacks capacity and has no agent, designated surrogate, or conservator reasonably available, the supervising health care provider identifies a surrogate and documents it in the clinical record. That surrogate must decide according to the patient's known wishes, or otherwise in the patient's best interest. It works, but it puts the choice of decision-maker in someone else's hands — which is exactly what naming an agent in advance prevents.