Delaware's DMOST Is Now POLST: What the Change Means
If you've ever completed an advance care planning conversation with a doctor or an elder law attorney in Delaware, you may know the DMOST form. That name is going away. With the Governor's signature on Senate Bill 274, Delaware's Medical Orders for Scope of Treatment (DMOST) is now the Delaware Portable Orders for Life-Sustaining Treatment, or POLST.
The update is more than a new label. Here's a plain-language look at what changed and what it means for you and your family.
Why the name changed
POLST is the term used for this type of medical order across the country. By adopting it, Delaware lines up with a national effort to create a more uniform form, one that is easier to recognize and honor as patients move between hospitals, nursing facilities, home care, and other settings.
Your existing DMOST form is still good
This is the most important takeaway for anyone who already has a completed form. The new law includes a savings provision, so the rename does not undo or weaken DMOST forms that have already been signed. There is no need to start over or redo paperwork you've already finished.
A new statewide POLST form is expected in January. Until it is released, health-care practitioners should keep using the current DMOST forms.
Other changes in SB 274
Beyond the rename, the law adjusts several rules to better match the national model and Delaware's recently enacted Uniform Health-Care Decisions Act.
More practitioners can assess decision-making capacity. Previously, any licensed practitioner authorized to write medical orders could complete a POLST form, but only a physician could decide that a patient lacked the capacity to sign one. Now, any practitioner who is authorized to complete the form can make that call.
The finding must be documented. A practitioner who determines a patient lacks capacity must record that finding in the patient's medical record. The law also makes clear that an authorized representative cannot sign a POLST form on the patient's behalf unless that documentation is in place. This adds a safeguard so that decisions made for someone else rest on a clear, written determination.
Limits on a representative's authority were updated. Certain provisions about a patient's ability to restrict their authorized representative's future power to change the POLST orders conflicted with the national model law. The new law removes those provisions.
Housekeeping edits. The bill also makes technical corrections so Delaware's code follows the state's legislative drafting standards, including updating other sections of the law that referred to the DMOST by its old name.
What you should do now:
- If you already have a DMOST form: keep it. It remains valid.
- If you're thinking about completing one: talk with your physician or other health-care practitioner about whether a POLST is appropriate for your situation, and watch for the new statewide form in January.
- If you serve as someone's health-care agent or representative: be aware that the patient's lack of capacity must be documented in their medical record before you can sign a POLST form for them.
- Review the rest of your plan: a POLST works alongside, not in place of, documents like an advance health-care directive and a durable power of attorney. Changes like this are a good reason to make sure everything still fits together.
We're here to help
A POLST is a medical order, so it is completed with your health-care practitioner. But it should reflect the wishes you've laid out in your broader estate and advance care plan. If you have questions about how these updates affect you or a loved one, the team at Procino-Wells & Woodland is happy to help.
Sources: Delaware General Assembly (SB 274) and the Delaware Health Care Facilities Association. This post is for general information only and is not legal advice.