At Wednesday’s Public Health Council meeting the Department of Public Health presented its draft regulations (PDF) for implementing Section 227 of Chapter 224. This section focuses on providing information to appropriate patients about palliative care and end-of-life care options.
There are four parts in the section. The first contains definitions of terms. The second part directs the DPH Commissioner (for some reason the law was written this so that the Commissioner, rather than the Public Health Council, shall promulgate the regulations, so after the public comment period, the Commissioner will make the final decision on the regulations and bring those to the Council) to adopt regulations requiring hospitals, nursing homes and health centers to distribute information on palliative care and end-of-life care options to appropriate patients. It also mentions assisted living facilities, but DPH does not regulate those facilities. It will work with the Executive Office of Elder Affairs on this piece. The third part does not apply to DPH but to the Board of Registration in Medicine and the Board of Registration in Nursing because it speaks to attending health care practitioners offering to provide patients with information and counseling (DPH staff said they will be working with these Boards on implementation). The fourth part directs DPH to work with the Hospice and Palliative Care Federation to develop the related information, rules and regulations.
Under the draft regulations, the covered facilities will be required to:
- Have a process to identify appropriate patients;
- Ensure that appropriate patients receive information;
- Distribute information about hospice and palliative care in a timely manner;
- Inform all physicians and nurse practitioners of the requirement to provide end-of-life counseling to patients with a terminal illness or condition (This is the section that is under the Boards of Registration in Medicine/Nursing-and it should actually say that it is a requirement to OFFER to provide counseling to patients).
DPH can request to see the facility’s process and policy and to review it. One suggestion from a Council member was for DPH to develop a model policy to distribute to facilities.
The regulations require facilities to distribute to appropriate patients culturally and linguistically suitable information regarding the availability of hospice and palliative care. They can either use a DPH-issued informational pamphlet (which they are drafting) or a facility-created pamphlet. The pamphlet must at least include:
- Definition and explanation of advanced care planning, hospice care and palliative care;
- Other requirements defined in the guidance of the Department.
It is wonderful to see the specific requirement about culturally and linguistically suitable information. However, the actual implementation of this is not something to be taken lightly. Some cultures have very strong feelings regarding talking about death. Will facilities be able to conduct focus groups or hire consultants from specific communities who can assist them in developing this information in a culturally appropriate way? DPH may have to get further involved in this piece to ensure that this is done correctly.
DPH will issue guidance for facilities suggesting that they include the following components in an informational pamphlet:
- FAQs about hospice, palliative care, and patient legal rights;
- A MOLST form and explanation;
- Conversation tools to encourage discussions with family and providers;
- List of licensed hospice providers near the facility.
Other comments from Council members included asking about efforts to engage the faith community and also to get the information out to health care workers other than those in the covered facilities. For example, community health workers, home health workers, and many others interact regularly with patients who may want/need this information. Even within hospitals, it was mentioned that it should not just be the doctor or nurse who gets this information to distribute but social workers, chaplains, etc. Council members suggested that DPH work with the Department of Developmental Services and the Department of Veteran’s Services to reach populations who may not otherwise be reached. Council members talked a lot about the need to educate the public. For example, many individuals do not understand that receiving palliative care does not mean that you are stopping all treatment for your condition.
We hope that the Boards of Registration will work closely with DPH to ensure that the section covering individual health care practitioners is implemented. It is often in the outpatient setting that this type of information and counseling needs to be provided to patients and families.
There will be a public hearing on November 21 (time TBD – check the DPH website or our blog) during which DPH will gather testimony regarding these draft regulations. You can also submit written testimony if you are unable to attend the hearing in person.
Next month’s Public Health Council meeting will include a presentation from DPH staff on the recently released report on flu vaccination of healthcare workers. See our blog on the report here. That meeting will be on Wednesday, November 13, 9am at DPH.