CT Golden Years: Hospice Facilities Bill Approved by Legislature, to Provide Alternative Care for Terminally Ill

May 16, 2012
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The state Legislature has approved a bill that would provide terminally ill people with the option of receiving hospice care in a special facility. It awaits the signature of Gov. Dannel Malloy.

Proponents of the bill envision providing 24-hour care in facilities around the state similar to the care that hospice organizations provide for people in their homes. They also said the new law will allow hospices to build residences with 12 or fewer beds in areas that would be accessible for families and allow patients to stay in their communities.

The compromise bill that passed last Wednesday would allow more hospice organizations to offer inpatient services to people with advanced, irreversible illnesses.

Ron Winter

Under the bill, two types of hospices are defined – a “short-term hospital special hospice,” and the new “hospice facility” category, which allows existing hospice organizations to create inpatient facilities. The Department of Public Health also is reviewing draft regulations for hospices.

Prior to the current legislation, a Department of Public Health licensed or Medicare-certified hospice was allowed to operate a specialized residence for the terminally ill that provides hospice home care and supportive services. The bill authorizes only a DPH-licensed hospice to operate a residence and allows the hospice to also operate a “hospice facility” that provides hospice home care or hospice inpatient services. (According to text accompanying the legislation the bill does not distinguish between a facility and a residence.)

According to the bill’s summary it requires a residence to provide a home-like atmosphere for patients for an appropriate time period, and cooperate with the Department of Public Health to develop licensing and operational standards.

Currently, DPH regulates hospices that are considered free-standing or established as a unit within a health care facility. DPH regulations define “hospice” under the broader category of “short-term hospital special hospice.”

Inpatient hospice facilities must meet a variety of requirements concerning physical plant, administration, staffing, records, and infection control. A home care program offered by an institutionally based hospice is also subject to DPH regulations. The program must address the physical, psychological, and spiritual needs of the patient and family and provide services 24 hours a day, seven days a week.

In March 2011, DPH published notice of its intent to amend these regulations to create a second category for inpatient hospice facilities called “hospice facility.” The proposal keeps the existing “short-term hospital special hospice” category so that facilities that want to continue to provide hospice services at a hospital level of care may do so.

The new “hospice facility” category would allow the establishment of new facilities under regulations based on Medicare’s minimum regulatory requirements for inpatient hospital facilities which are less stringent than the department’s current short-term hospital special hospice regulations.

Hospice care is specialized in that it is directed toward terminal patients, and it offers a full range of services to the extended family as well as the patient. Hospice care can include medical assistance through doctor and nursing visits, nutritional advice, home care assistance, social workers, and religious counseling. Organizations that supported the bill want to make this assistance available throughout the state, for dying patients and their families who may not be able to provide care for the patients at home.

Advocates for the new law testified that the need for specialized care has been clearly demonstrated and noted that plans to build hospice facilities around the state were jeopardized because the existing regulations do not recognize hospice residences.

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