What is MOLST?
MOLST (Medical Orders for Life-Sustaining Treatment) is a discussion and medical orders that give patients more control over their end-of-life care. The MOLST form specifies the types of treatments a patient wishes to receive toward the end of life. Completing a MOLST document requires communication between healthcare providers and patients, which enables patients to make more informed decisions about their medical treatment. The MOLST order documents patient’s decisions in a clear manner and can be quickly understood by all providers, including first responders and emergency medical services (EMS) personnel. As a result, the patient’s wishes can be honored across all settings of care.
Is a MOLST form required for all patients?
No. Completion of the MOLST form is voluntary. In Connecticut, the process is intended for individuals nearing the end stage of a life-limiting illness or in a state of advanced progressive frailty.
Should all nursing home residents or assisted living residents have a MOLST?
No. The fact that an individual may be living in a nursing home or assisted living does not automatically qualify them for a MOLST. Patients who choose to have a MOLST must be in the end stage of a serious life limiting illness, AND/OR be in a condition of advanced chronic progressive frailty.
Who should complete a MOLST?
Every patient who is either (1) approaching the end stage of a serious life limiting illness; or (2) in a condition of advanced chronic progressive frailty should have awareness of the option of a MOLST. However, MOLST is voluntary, and a patient who meets the above criteria may not wish to complete a MOLST.MOLST is NOT intended for those with significant disabilities who choose to live with the assistance of life supporting interventions, e.g., medical feeding or ventilators.
Who can be an eligible provider?
Any physician (MD/DO), advanced practice registered nurse (APRN), or physician assistant (PA) who has completed the Department of Public Health (DPH)-approved training module.
What if a patient has an advance directive such as a living will?
The MOLST document reinforces the wishes that a patient expresses in an advance health care directive. The MOLST document remains with the patient and is a medical order that should be used to direct the care for the patient. Often the advance health care directive (AHCD) is not readily available, or questions exist about the decision-making capacity of a patient and whether the AHCD is in effect. It is recommended that patients who are approaching the end stage of a serious life limiting illness or who are in a condition of advanced chronic progressive frailty have both an AHCD and a MOLST.
What is a Legally Authorized Representative (LAR)?
As defined in Conn. Gen. Stat. § 19a-580h, a legally authorized representative (LAR) is someone who is legally authorized to make decisions in accordance with your wishes if you are incapable of making decisions. A LAR can be your parent, guardian, health care representative, or conservator.A health care representative is a person appointed in writing under Conn. Gen. Stat. §§ 19a-576 and 19a-577 to make any and all health care decisions on a person’s behalf when the person is unable to communicate his or her decisions about medical care.
I am a provider who was trained in MOLST prior to the 2024 legislation removing the witness signature requirement. Do I need to retake the training to remain an eligible provider?
Although eligible providers who were trained prior to the 2024 legislative changes do not need to retake the training, DPH and the MOLST Advisory Council strongly recommend that providers review the changes to the policies & procedures to familiarize themselves with executing, amending, and revoking a MOLST.
Is MOLST the same as an advance directive?
No, MOLST does not replace an advance directive such as a living will. The advance directive can provide significantly more detail about an individual’s wishes and preferences for treatment.
Is the MOLST simply a DNR order?
No, MOLST is a document that empowers a patient or, when appropriate, their legally authorized representative (LAR) to make decisions along the whole continuum of care. Treatment approaches range from very aggressive life sustaining care to comfort care only, including choices about full resuscitation or do not attempt resuscitation.
Will the DNR Bracelet still be honored by EMS?
Yes, the DNR Bracelet is still a valid method to communicate a patient’s intent about attempts to resuscitate. There are many of these bracelets in use, and EMS personnel will continue to honor this directive. DNR is just one component of a patient’s wishes. Learn more about Connecticut’s DNR Program here.
Why is the MOLST form no longer lime green?
The MOLST Advisory Council determined that a digital-first approach was patient-centered and expanded access for patients and providers. All eligible health care providers should provide a paper copy of a MOLST order to their patient after the conversation. A MOLST form does not need to be lime green or otherwise printed in color to be considered valid.
Does the MOLST form travel with the patient between settings of care?
Yes, the MOLST form is designed to be a standard form that may be accepted by all providers across the state. As a set of legal medical orders, it can be honored by providers and facilities such as but not limited to EMS, hospitals, long-term care facilities, home care and hospice providers.Outside of Connecticut, the MOLST instructions may be honored in some states but not in others. However, a MOLST form is always a good record of a person’s treatment decisions. Patients who reside in (or spend time regularly in) multiple states are recommended to discuss MOLST/POLST/POST orders with clinicians in both states.
How do I access the MOLST form?
The form is available online on the MOLST homepage under the section titled "MOLST Training and Form."
Where is the family encouraged to keep the form?
While MOLST uses a digital-first approach to document an individual’s wishes, the eligible healthcare provider is strongly encouraged to send a paper copy of the MOLST form home with the individual. The paper copy of the MOLST form should be kept where it can easily be seen by emergency services personnel (e.g.refrigerator door, the back of the individual’s bedroom door).
Which Physician (MD/DO), Advanced Practice Registered Nurse (APRN) or Physician Assistant (PA) should sign the MOLST form?
Any Connecticut-licensed MD/DO, APRN, or PA can sign a MOLST if they have received DPH-approved MOLST training and have had the MOLST conversation with the patient or their LAR.
When should the MOLST form be reviewed?
The eligible provider should review the MOLST form in discussion with the patient or their LAR as necessary if clinically appropriate or if the patient’s preferences change.
Can the MOLST form be completed or voided without a conversation with the patient or their Legally Authorized Representative?
No. The MOLST form cannot be completed, changed, or voided unless there is a conversation with either the patient or, if the patient lacks capacity, the patient’s LAR.
Can a patient make a decision that differs from their MOLST preferences in an emergent situation?
Yes. A patient may verbally or otherwise indicate treatment preferences that are different than written on their MOLST in the moment. This does NOT alter their written MOLST preferences. Once stabilized, the eligible provider is encouraged to revisit the MOLST conversation and preferences with their patient, to ensure their goals of care are accurately reflected.
How can an eligible provider void a MOLST form, following a conversation with their patient?
To void a digital MOLST form following a conversation, the eligible provider shall complete and sign the review section on the MOLST form to indicateeither “Form Voided New Form Completed” or “Form Voided – No New Form.” If the patient has a paper copy of their MOLST, the paper copy shall be discarded.
Why isn’t the MOLST form considered an advance directive?
The MOLST form is not an advance directive because it is a medical document that contains actionable medical orders that are effective immediately based on a patient's current medical condition. Advance directives, including health care representatives and living wills, are legal documents that are effective only after the patient has lost capacity. In other words, a health care representative can make decisions for a person only after he or she has been determined to lack capacity; a living will is relevant only after the patient can no longer be consulted. A MOLST form, on the other hand, is a medical document signed by both the eligible provider and the patient, and is effective as soon as it is signed, regardless of a patient’s capacity to make decisions.
Does every section of the MOLST form need to be filled out for the form to be valid?
Yes, in order for the MOLST to be valid, all sections must be filled in and legible.In conversations where the patient has uncertainty, there is an “Undecided” option. In the situations where the patient is undecided, full treatment will be provided.
When does the MOLST form expire?
The MOLST form does not expire. Reviewing the MOLST form with patients frequently is a best practice.
Who may discuss advance care planning (such as advance directives or MOLST) with an individual?
Advance care planning is an umbrella term for legal and medical orders, including living wills, advance directives, and medical orders. Health professionals such as nurses or social workers may educate individuals about advance care planning, however, discussions that involve medical treatment decisions, such as MOLST, must be completed by an eligible provider.