Palliative Care
PDF Version of DQA 09-042
(PDF, 67 KB)
| Date: |
October 26, 2009 |
| To: |
Home Health Agencies HHA 11
Hospitals HOSP 16
Nursing Homes NH 22 |
| From: |
Alfred Johnson, Director
Bureau of Technology, Licensing and Education |
| Via: |
Otis Woods, Administrator
Division of Quality Assurance
|
Palliative Care
The purpose of this memorandum is to provide information and guidance on
the meaning of palliative care and expectations for palliative and
supportive care programs.
Under Wisconsin Law, no person may conduct, maintain, or operate a
hospice unless the hospice is licensed by the department the Department of
Health Services.1 The statutes mandate that the Department provide uniform,
statewide licensing, inspection and regulation of hospices.2
The Division of Quality Assurance (DQA) recognizes, however, a national
trend for hospice agencies and other Department-regulated entities to offer
palliative and supportive services to individuals who are not terminally ill
or who choose not to be admitted to hospice.3 The DQA is aware that other
state entities are offering palliative and supportive service programs.
First and foremost, it is important to note that, while there may be no
state statutes or administrative codes (other than those relating to hospice
agencies) that specifically reference "palliative care" or
"supportive care", the delivery of such care by regulated entities
remains subject to existing statutory and code standards for provision of
care.
The World Health Organization (WHO) definition of palliative care
provides a foundation and context for palliative care in all settings. The
WHO definition of palliative care is:
Palliative care is an approach that improves the quality of life of
patients and their families facing the problem associated with
life-threatening illness, through the prevention and relief of suffering
by means of early identification and impeccable assessment and treatment
of pain and other problems, physical, psychosocial and spiritual.
Palliative care:
- Provides relief from pain and other distressing symptoms;
- Affirms life and regards dying as a normal process;
- Intends neither to hasten or postpone death;
- Integrates the psychological and spiritual aspects of patient care;
- Offers a support system to help patients live as actively as possible
until death;
- Offers a support system to help the family cope during the patient's
illness and in their own bereavement;
- Uses a team approach to address the needs of patients and their
families, including bereavement counseling, if indicated;
- Will enhance the quality of life, and may also positively influence
the course of illness;
- Is applicable early in the course of illness, in conjunction with
other therapies that are intended to prolong life, such as chemotherapy
or radiation therapy, and includes investigations needed to better
understand and manage distressing clinical complications.4
The National Consensus Project for Quality Palliative Care issued
Clinical Practice Guidelines for Quality Palliative Care, Second Edition
in 2009. These guidelines incorporate the use of the illustration below,
which exemplifies palliative care's place in the course of illness.
5
Palliative care is provided while an individual may be receiving
life-prolonging therapy, as well as once the individual has elected the
hospice benefit. The expectation is that, when an individual reaches the
terminal stage of an illness, hospice options are explored.
The DQA expects entities promoting palliative and supportive care
programs as a service to utilize current standards of practice as a basis
for their programs. Below is a sample of websites which contain additional
information regarding current palliative care standards of practice and a
wealth of information related to palliative care:
Entities may expect DQA surveyors to review palliative care services and
programs during the course of surveys. Applicable regulations may include:
Home Health Agencies
Federal Regulations:
42 CFR §484.12(c) - Standard: Compliance with accepted professional
standards and principles.
State Regulations:
Wis. Admin. Code § DHS 133.05(1) (b) - Governing Body;
Wis. Admin. Code § DHS 133.08(1) and (2) - Patient Rights;
Wis. Admin. Code § DHS 133.09 - Acceptance and discharge of patients;
Hospitals
Federal Regulations:
42 CFR §482.11(a) - Compliance with Federal Laws,
42 CFR §482.13(b) (1) - Patient Rights/Participate in Plan of Care
State Regulations:
Wis. Admin. Code § DHS 124.05(3) (a) 1.g. - Patient Right/Governing
Board
Nursing Homes
Federal Regulations:
42 CFR §483.10(b) (4) - F155, Right to Refuse Treatment
§42 CFR 483.10(b) (11) - F157, Notification of Changes
42 CFR §483.10(d) (3) - Right to Participate in Care Plan
42 CFR §483.15(b) - F242, Self Determination and Participation
42 CFR §483.20 - F272, Comprehensive Assessment
42 CFR §483.20(k) - F279, Comprehensive Care Plan
42 CFR §483.10(d) (3) - F280, Comprehensive Care Plan Revision
42 CFR §483.20(k) (3) - F281, Services provided meet professional
standards of quality
42 CFR §483.25 - F309, Quality of Care
42 CFR §483.40(a) - F385, Physician Services
42 CFR §483.60 - F425, Pharmacy Services
42 CFR 483.75(b) - Compliance with Federal Law Standards of Practice
42 CFR §483.75(i) (2) - F501, Medical Director
State Regulations:
Wis. Admin. Code § DHS 132.51(2) - Other Limitations on Admissions
Wis. Admin. Code § DHS 132.52 - Procedures for admission
Wis. Admin. Code § DHS 132.53 - Transfers and discharges
Wis. Admin. Code § DHS 132.60 - Resident Care
Wis. Admin. Code § DHS 132.60(1) (c) 5 - Provide appropriate assessment
and
treatment of pain
Wis. Admin. Code § DHS 132.60(3) - Notification of Changes in Condition
or Status of
Resident
Wis. Admin. Code § DHS 132.60(8) - Resident Care Planning
Wis. Admin. Code § DHS 132.61 - Medical Services
Wis. Admin. Code § DHS 132.65 - Pharmaceutical Services
If you have questions regarding palliative care programs, please contact:
Home Health Agencies: Marianne Missfeldt at marianne.missfeldt@dhs.wi.gov
Hospitals: Doug Englebert at douglas.englebert@dhs.wi.gov
Nursing Homes: Vicky Griffin at victoria.griffin@dhs.wi.gov
cc: Hospices
1 Wis. Stat. § 50.92
2 Wis. Stat. § 50.91
3 Code Ch. DHS 131, to qualify as a hospice an agency must be
"primarily" engaged in providing palliative and supportive care
to individuals with terminal illness, which is a life expectancy of less
than 12 months.
4 WHO 2008
5 Illustration used with permission
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