Senate Bill No. 1004

Introduced by Senator Hernandez

February 13, 2014

An act to amend Section 1746 of the Health and Safety Code, relating to health facilities.

LEGISLATIVE COUNSEL’S DIGEST

SB 1004, as introduced, Hernandez. Health facilities: hospice care.

Existing law defines “hospice” as a specialized form of interdisciplinary health care that is designed to provide palliative care, alleviate the physical, emotional, social, and spiritual discomforts of an individual who is experiencing the last phases of life due to the existence of a terminal disease, and provide supportive care to the primary caregiver and the family of the hospice patient, and that meets specified criteria, including, but not limited to, providing for the palliative medical treatment of pain and other symptoms associated with a terminal disease, but does not provide for efforts to cure the disease.

This bill would revise the definition of “hospice” so that the palliative medical treatment would no longer be limited to those treatments that do not provide for efforts to cure the disease.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

SECTION 1.  

Section 1746 of the Health and Safety Code is
amended to read:

1746.  

For the purposes of this chapter, the following definitions
apply:

(a) “Bereavement services” means those services available to
the surviving family members for a period of at least one year after
the death of the patient, including an assessment of the needs of
the bereaved family and the development of a care plan that meets
these needs, both prior to and following the death of the patient.

(b) “Home health aide” has the same meaning as that term is
defined in subdivision (c) of Section 1727.

(c) “Home health aide services” means those services described
in subdivision (d) of Section 1727 that provide for the personal
care of the terminally ill patient and the performance of related
tasks in the patient’s home in accordance with the plan of care in
order to increase the level of comfort and to maintain personal
hygiene and a safe, healthy environment for the patient.

(d) “Hospice” means a specialized form of interdisciplinary
health care that is designed to provide palliative care, alleviate the
physical, emotional, social, and spiritual discomforts of an
individual who is experiencing the last phases of life due to the
existence of a terminal disease, and provide supportive care to the
primary caregiver and the family of the hospice patient, and that
meets all of the following criteria:

(1) Considers the patient and the patient’s family, in addition
to the patient, as the unit of care.

(2) Utilizes an interdisciplinary team to assess the physical,
medical, psychological, social, and spiritual needs of the patient
and the patient’s family.

(3) Requires the interdisciplinary team to develop an overall
plan of care and to provide coordinated care that emphasizes
supportive services, including, but not limited to, home care, pain
control, and limited inpatient services. Limited inpatient services
are intended to ensure both continuity of care and appropriateness
of services for those patients who cannot be managed at home
because of acute complications or the temporary absence of a
capable primary caregiver.

(4) Provides for the palliative medical treatment of pain and
other symptoms associated with a terminal disease begin delete , but does not
provide for efforts to cure the disease end delete .

(5) Provides for bereavement services following death to assist
the family in coping with social and emotional needs associated
with the death of the patient.

(6) Actively utilizes volunteers in the delivery of hospice
services.

(7) To the extent appropriate, based on the medical needs of the
patient, provides services in the patient’s home or primary place
of residence.

(e) “Hospice facility” means a health facility as defined in
subdivision (n) of Section 1250.

(f) “Inpatient care arrangements” means arranging for those
short inpatient stays that may become necessary to manage acute
symptoms or because of the temporary absence, or need for respite,
of a capable primary caregiver. The hospice shall arrange for these
stays, ensuring both continuity of care and the appropriateness of
services.

(g) “An interdisciplinary team” means the hospice care team
that includes, but is not limited to, the patient and patient’s family,
a physician and surgeon, a registered nurse, a social worker, a
volunteer, and a spiritual caregiver. The team shall be coordinated
by a registered nurse and shall be under medical direction. The
team shall meet regularly to develop and maintain an appropriate
plan of care.

(h) “Medical direction” means those services provided by a
licensed physician and surgeon who is charged with the
responsibility of acting as a consultant to the interdisciplinary
team, a consultant to the patient’s attending physician and surgeon,
as requested, with regard to pain and symptom management, and
a liaison with physician and surgeons in the community.

(i) “Multiple location” means a location or site from which a
hospice makes available basic hospice services within the service
area of the parent agency. A multiple location shares
administration, supervision, policies and procedures, and services
with the parent agency in a manner that renders it unnecessary for
the site to independently meet the licensing requirements.

(j) “Palliative care” means patient and family-centered care that
optimizes quality of life of a patient with a terminal illness by
anticipating, preventing, and treating suffering. Palliative care
throughout the continuum of illness involves addressing physical,
intellectual, emotional, social, and spiritual needs and to facilitate
patient autonomy, access to information, and choice.

(k) “Parent agency” means the part of the hospice that is licensed
pursuant to this chapter and that develops and maintains
administrative control of multiple locations. All services provided
from each multiple location and parent agency are the responsibility
of the parent agency.

(l) “Plan of care” means a written plan developed by the
attending physician and surgeon, the medical director or physician
and surgeon designee, and the interdisciplinary team that addresses
the needs of a patient and family admitted to the hospice
organization. The hospice shall retain overall responsibility for
the development and maintenance of the plan of care and quality
of services delivered.

(m) “Preliminary services” means those services authorized
pursuant to subdivision (d) of Section 1749.

(n) “Skilled nursing services” means nursing services provided
by or under the supervision of a registered nurse under a plan of
care developed by the interdisciplinary team and the patient’s
physician and surgeon to a patient and his or her family that pertain
to the palliative, supportive services required by patients with a
terminal illness. Skilled nursing services include, but are not limited
to, patient assessment, evaluation and case management of the
medical nursing needs of the patient, the performance of prescribed
medical treatment for pain and symptom control, the provision of
emotional support to both the patient and his or her family, and
the instruction of caregivers in providing personal care to the
patient. Skilled nursing services shall provide for the continuity
of services for the patient and his or her family. Skilled nursing
services shall be available on a 24-hour on-call basis.

(o) “Social services/counseling services” means those counseling
and spiritual care services that assist the patient and his or her
family to minimize stresses and problems that arise from social,
economic, psychological, or spiritual needs by utilizing appropriate
community resources, and maximize positive aspects and
opportunities for growth.

(p) “Terminal disease” or “terminal illness” means a medical
condition resulting in a prognosis of life of one year or less, if the
disease follows its natural course.

(q) “Volunteer services” means those services provided by
trained hospice volunteers who have agreed to provide service
under the direction of a hospice staff member who has been
designated by the hospice to provide direction to hospice
volunteers. Hospice volunteers may be used to provide support
and companionship to the patient and his or her family during the
remaining days of the patient’s life and to the surviving family
following the patient’s death.