Advance Directives in New Jersey: A 72-Hour Guide for Families

If you are reading this, your mom or dad is probably in a hospital bed in Newark or Jersey City or Paterson, and a social worker has just used a phrase you have not heard before. Advance directive. Proxy. Instruction directive. Code status. The doctors need an answer in the next day or two, and the answer depends on a piece of paper that may or may not exist.

This page is the one you wish you had found first. It tells you what the document is called in New Jersey, who is allowed to decide if there is no document, where to look for one, and what the next 72 hours are likely to ask of you. It is written for the family on the elevator going up to the ICU, not for the lawyer in the office.

New Jersey's Advance Directives for Health Care Act ( N.J.S.A. 26:2H-53 et seq.) recognizes a single document called the Advance Directive for Health Care. It can have two parts.

The first is the Proxy Directive. This is what most other states call a health care power of attorney or health care proxy. It names a person, called the health care representative, to make medical decisions when your parent cannot. The representative can consent to surgery, agree to or refuse a feeding tube, choose a nursing home, authorize hospice, and decide about life-sustaining treatment.

The second is the Instruction Directive. This is what most other states call a living will. It speaks directly to the medical team about life-sustaining treatment if your parent becomes terminally ill or permanently unconscious. It is narrower in scope than the Proxy Directive, but it is the document an ICU physician will reach for when the question is whether to continue a ventilator.

Five Wishes, the popular nationally-distributed booklet from Aging with Dignity, is valid in New Jersey as-is. New Jersey does not require any state-statutory-language attachment, notice statement, or extra acceptance form. The booklet must be signed under New Jersey's execution rules (two adult witnesses or notary acknowledgment).

Here New Jersey is different from most states in a way that matters. Most states have a clear statutory list of who decides when no advance directive exists. Pennsylvania has 20 Pa.C.S. § 5461. Ohio has R.C. § 2133.08. New Jersey has no equivalent for general clinical decisions.

What New Jersey has instead is the Advance Directives for Health Care Act and decades of NJ case law on substituted judgment. The two foundational cases are In re Quinlan (1976), the first US case to recognize a right to refuse life-sustaining treatment, and In re Conroy (1985), which established the framework still used by NJ hospitals when no directive exists. Together, those cases tell the medical team to honor the patient's known wishes (or, where wishes are not known, the patient's best interests), with family input.

In practice, NJ hospitals turn to family members in a customary order: the spouse or domestic partner first, then adult children, then parents, then adult siblings, then the nearest adult relative. This is consistent with the substituted-judgment framework but is not a numbered list in the statute. It relies on the family arriving at a decision together.

That gap is the strongest argument for completing a Proxy Directive in New Jersey, more so than in most other states. The Proxy Directive replaces an ambiguous family conversation in the ICU with a single named representative who has clear authority.

Most New Jersey adults who completed an advance directive have a copy in one of five places. Check them in this order, because the easiest ones are also the most likely.

1. The hospital admissions packet. If your parent has been admitted to this hospital before, the directive may already be scanned into the electronic medical record. Ask the floor nurse or the social worker.
2. The primary care doctor's chart. Most NJ primary care offices keep a copy. Call the office and ask them to fax or send a copy to the hospital.
3. A home filing cabinet or desk drawer. Most people store the signed original with their will, their birth certificate, and their Social Security card.
4. A safe-deposit box. Common but inconvenient in an emergency, because the bank may require a court order to open the box without the named holder.
5. The estate-planning attorney's file. If your parent worked with an attorney on a will or trust, that attorney almost certainly has a copy of the advance directive on file.

In a typical New Jersey hospital admission for an older adult, five questions tend to land on the family within the first three days. Knowing they are coming makes it easier to face them.

Code status. Does your parent want CPR if their heart stops? Does your parent want to be put on a breathing machine? NJ hospitals will ask this on admission, and the default is full code (everything done). If your parent has an Instruction Directive and a separate POLST or DNR order, bring both. An Instruction Directive alone is not a DNR; the medical team needs the order signed by a physician.

Feeding tube. If your parent cannot swallow safely after a stroke or a serious illness, the team may ask about a feeding tube. The NJ Instruction Directive form addresses nutrition and hydration in a specific section, so the document itself often gives the answer.

Hospitalization versus hospice.If the underlying illness is terminal, the question may be whether to keep treating in the hospital or move to hospice. Hospice care can happen at home, in a nursing facility, or in a free-standing hospice house. Your parent's wishes drive this choice.

Who is the representative. If there is a Proxy Directive, confirm with the hospital that the named representative is on file and can be reached. If the representative is unreachable, the named alternate steps in.

Discharge plan. Once your parent is medically stable, the question becomes where to go next. Home, with home health. A skilled nursing facility for short-term rehab. A long-term care facility. Hospice. The advance directive informs this conversation but does not decide it; that is what the discharge planner is for. Search New Jersey facilities to compare options.

Sitting in a hospital waiting room is a strange place to think about your own mortality. It is also the most clarifying. Most people who watch a parent go through this resolve, sometimes inside the first day, that they will not put their own children through the same ambiguity. The way to keep that resolution is to act on it before the feeling fades.

Tonight or tomorrow, complete your own Proxy Directive and Instruction Directive. The New Jersey Department of Health publishes a model packet that covers both, and is accepted at every NJ hospital. It takes about twenty minutes. The packet walks you through naming a representative, choosing an alternate, and telling your future medical team whether you would want life-sustaining treatment if you were terminally ill or permanently unconscious.

Once it is signed, name your representative out loud. Tell them. Send them a copy. Send a copy to your primary care doctor. Tape one to the inside of a kitchen cabinet where someone will find it if they need it. The document does not work if no one knows it exists.

• New Jersey Department of Health: Advance Directive for Health Care The official state explainer plus a downloadable advance directive packet (Proxy Directive and Instruction Directive).
• N.J.S.A. 26:2H-53 et seq. The full New Jersey Advance Directives for Health Care Act, including the definitions of proxy directive and instruction directive and the execution requirements.
• New Jersey Office of the Long-Term Care Ombudsman Free advocacy if you have a complaint or concern about a nursing facility, assisted living, or home care provider in New Jersey.
• New Jersey State Bar Association: Lawyer Referral Service If your situation needs a lawyer, this is the official referral path.