Advance Directives in Pennsylvania: A 72-Hour Guide for Families

If you are reading this, your mom or dad is probably in a hospital bed in Philadelphia or Pittsburgh or Allentown, and a social worker has just used a phrase you have not heard before. Advance directive. Health care power of attorney. Living will. 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 Pennsylvania, 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.

Pennsylvania recognizes two separate documents that together act as a complete advance directive. Most Pennsylvania adults sign both at the same time, sometimes on a single combined form distributed by their hospital or attorney.

The first is the Health Care Power of Attorney, governed by 20 Pa.C.S. Chapter 54 (specifically § 5452 through § 5460). This document names a person, called the agent, to make medical decisions when your parent cannot. The agent can consent to surgery, agree to or refuse a feeding tube, choose a nursing home, authorize hospice, and (with limits) decide about life-sustaining treatment.

The second is the Living Will, governed by 20 Pa.C.S. § 5442 through § 5446. This document speaks directly to the medical team about life-sustaining treatment when your parent has an end-stage medical condition or is permanently unconscious. It is narrower in scope than the Health Care Power of Attorney, 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 Pennsylvania as-is. Pennsylvania does not require any state-statutory-language attachment, notice statement, or extra acceptance form. The booklet must be signed under Pennsylvania's witness rules (two adult witnesses, none of whom are the agent or the principal's attending health care provider).

If your parent never signed a Health Care Power of Attorney and never signed a Living Will, the hospital does not get to pick a decision-maker, and you do not either. Pennsylvania statute does. The relevant section is 20 Pa.C.S. § 5461(d), which lists the default health care representative when no advance directive exists.

The priority order is:

1. The spouse, unless an action for divorce is pending, plus any adult child of the principal who is not also a child of that spouse.
2. An adult child.
3. A parent.
4. An adult brother or sister.
5. An adult grandchild.
6. An adult who has knowledge of the principal's preferences and values, including religious and moral beliefs.

Pennsylvania's sixth tier is broader than most states because it reaches a close friend or long-term partner who knows the principal's wishes well. That is more flexible than Ohio or many other states, but it is still slower and less clean than naming an agent in writing while everyone is well.

Most Pennsylvania 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 Pennsylvania 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 Pennsylvania 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? Pennsylvania hospitals will ask this question on admission, and the default is full code (everything done). If your parent has a Living Will and a separate POLST or DNR order, bring both. A Living Will 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 Pennsylvania Living Will 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 agent. If there is a Health Care Power of Attorney, confirm with the hospital that the named agent is on file and can be reached. If the agent 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 Pennsylvania 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 Health Care Power of Attorney and Living Will. The Pennsylvania Department of Aging publishes a fillable packet, and most major Pennsylvania health systems publish their own versions. Either is accepted at every Pennsylvania hospital. It takes about twenty minutes. The packet walks you through naming an agent, choosing an alternate, and telling your future medical team whether you would want life-sustaining treatment if you were end-stage or permanently unconscious.

Once it is signed, name your agent 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.

• Pennsylvania Department of Aging: Advance Directives The official state explainer plus a downloadable advance directive packet (Health Care Power of Attorney and Living Will).
• 20 Pa.C.S. Chapter 54 The full Pennsylvania advance health care directive statute (Living Will at § 5442 et seq., Health Care Power of Attorney at § 5452 et seq., surrogate hierarchy at § 5461).
• Pennsylvania Long-Term Care Ombudsman Free advocacy if you have a complaint or concern about a nursing facility, personal care home, or home care provider in Pennsylvania.
• Pennsylvania Bar Association: Lawyer Referral Service If your situation needs a lawyer, this is the official referral path.