The TPOPP form for nursing home residents is essential, and it’s different from advance directives. Families can use it to honor loved ones’ wishes in a crisis.
At VOYCE’s Empower and Protect Long-Term Care Conference on July 10, Dr. Charles Crecelius gave a powerful presentation on the importance of a critical document every nursing home resident and their family should understand: the TPOPP form.
TPOPP, which stands for Transportable Physician Orders for Patient Preferences, is also known nationally as POLST (Physician Orders for Life-Sustaining Treatment). Unlike advance directives or living wills, the TPOPP form turns a person’s medical preferences into real-time medical orders that must be followed by doctors, EMTs, hospitals, and long-term care staff.
Why Does My Loved One Need a TPOPP Form?
If your loved one lives in a nursing home or assisted living community, they may be dealing with complex or serious health conditions. The TPOPP form clearly spells out what level of medical care they want in the event of an emergency — whether that’s full treatment, limited interventions, or comfort care only.
Without a completed TPOPP, someone unfamiliar with your loved one’s wishes may make decisions in a moment of crisis. The TPOPP makes those wishes clear, helping families avoid painful decisions and reducing confusion for staff and emergency responders.
TPOPP vs. Advance Directives vs. the “Purple Form”
Understanding the differences between these documents can help you advocate effectively:
- Advance Directives express general healthcare preferences and designate a healthcare proxy. They are not medical orders and may not be followed during emergencies.
- The “Purple Form” (what many call Missouri’s out-of-hospital do-not-resuscitate, or DNR, orders, which are required to be printed on purple paper) is very limited in scope — it only covers resuscitation and nothing else.
- The TPOPP Form is comprehensive. It covers CPR preferences and medical interventions like hospitalization, IV fluids, antibiotics, and comfort-focused care — and it is a medical order, not just a guideline.
How to Have a Good Conversation About TPOPP for Nursing Home Residents
Start with your loved one’s goals and values. Ask:
- “What matters most to you if you get very sick?”
- “Would you want to go to the hospital, or stay in the nursing home and be kept comfortable?”
- Do you want to be on a breathing machine or have a feeding tube?
- “If your heart stopped or you couldn’t breathe, would you want to be resuscitated?”
These conversations can be emotional, but they’re essential. Once you and your loved one are on the same page, ask the nursing home’s medical director, physician, or nurse practitioner to help complete the TPOPP. A qualified medical doctor must sign the form for it to be valid.
Where to Keep It: Think TPOPP and the Vial of Life
Post a copy in your loved one’s nursing home room where staff can easily access it, and provide one for the facility to keep on file as well. If your loved one is ever transported to the hospital or returns home, make sure a copy travels with them.
For individuals living at home, use the Vial of Life method — keep the TPOPP in a labeled container (or taped to the fridge). Emergency responders are trained to look there. You can also store a copy in your glove compartment if your loved one often travels by car.
How to Get a TPOPP Form for Nursing Home Residents Made
- Talk to the doctor or nurse practitioner at your loved one’s long-term care facility.
- Visit https://missouripolst.org to download the Missouri version of the form.
- Schedule a conversation with your loved one’s care team — do not fill it out in a rush.
- Make sure a doctor signs the TPOPP, this is a requirement in Missouri for it to be valid.
- Keep the original safe and make lots of copies.
Ready to Get Started?
There are excellent resources for families and caregivers:
And of course, VOYCE is here to help. We can connect you with more information, guide conversations, and answer your questions about long-term care and planning.
Final Thoughts
It’s never too early—or too late—to start a conversation about what matters most. Having a TPOPP/POLST in place isn’t giving up hope. It’s protecting dignity, clarity, and control at a time when every second counts.
A TPOPP form for nursing home residents can bring peace of mind to families and protect older adults’ dignity, wishes, and safety. It’s more than paperwork — it’s a communication tool, a safeguard, and a gift of clarity for everyone involved.
If your loved one lives in a nursing home and does not yet have a TPOPP form, now is the time to start the conversation!