The u.s. congress enacted legislation that lead to hospice care throughout the united states.

Lawmakers and advocates are calling on legislators to move forward on legislation that would expand opportunities for interdisciplinary education and training in hospice and palliative care specialties. The call comes at a time when a growing aging population is straining providers’ ability to meet demand, even as the pandemic worsens turnover and complicates requirement and retention.

Sen. Tammy Baldwin (D-Wis.) and Rep. Yvette Clarke (D-N.Y.) recently penned a letter to congressional leaders in support of passing the Palliative Care and Hospice Education and Training Act (PCHETA). If enacted, PCHETA would include support for physician and nurse training in hospice and palliative care, among other interdisciplinary professions such as pharmacy, social work and chaplaincy. The bill also aims to expand continuing education and career development programs and incentives in these fields.

PCHETA would establish fellowship programs within new palliative care and hospice education centers to provide short-term, intensive training. PCHETA would also create training pathways through hospice and palliative care education centers, academic career awards and career incentive awards across all the relevant health care professions, both at the general and specialty levels. The courses would provide supplemental training for medical school faculty as well as other educators in health care fields such as nursing, pharmacy, psychology, social work and chaplaincy.

“Now is the time to address the needs of patients facing serious illness and their families,” Baldwin and Clarke stated in their letter. “To ensure access to palliative and hospice care for those who need it, we must support an interprofessional, team-based approach to care, and make the needed investments in the palliative care and hospice workforce. These investments must include efforts to address workforce development; health care provider training, including for physicians, nurses, and other health professionals; enhanced research; academic and career incentive awards; and increased education and awareness.”

PCHETA was initially passed by the House in 2018 and has come to the Senate twice, and is anticipated to be reintroduced in the 117th Congress (S.2080/H.R. 647) and referred to the U.S. Senate Committee on Health, Education, Labor and Pensions. 

The American Academy of Hospice and Palliative Medicine (AAHPM) supported the development of the legislation.

“Advancing PCHETA forward would go a long way towards improving quality of care and quality of life for our nation’s sickest and most vulnerable patients, along with their families and caregivers,” said AAHPM President Nathan Goldstein, M.D., in a statement shared with Hospice News.

Goldstein is also a physician in the department of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai New York.

If passed, PCHETA would also create special preferences in existing nurse education law for hospice and palliative nursing, in education, practice and quality grants, workforce development, and nurse retention projects.

PCHETA has broad bipartisan support and has received endorsements from more than 50 national organizations and 35 state organizations, according to Joe Rotella, M.D., AAHPM’s chief medical officer. Lawmakers are mulling the possibility of including some elements of PCHETA in a forthcoming reconciliation bill. Rotella told Hospice News that the effort is coming at a crucial time.

“For every day that goes by in which we aren’t investing in this, we’re just getting further and further behind,” said Rotella. “The investments in education and training that PCHETA calls for will make a big difference in meeting the future needs of the growing population of people with serious illness, but implementation will take time. We have to build the pipeline before we’ll see the results. Time is of the essence”

The nation’s aging population is driving up demand for serious illness and end-of-life care while also putting pressure on an already strained workforce. By 2060, seniors 65 and older are projected to represent nearly 25% of the U.S. population at 95 million, an uptick from 15% in 2016, according to the U.S. Census Bureau. As this group ages, it has shifted trends throughout the care continuum.

Hospice utilization among Medicare decedents rose to a new record in 2019 at 51.6%, a jump from 50.6% in 2018, according to the Medicare Payment Advisory Commission (MEDPAC).

Seriously ill patients who are not yet ready for hospice also have a growing need for palliative care. The Center to Advance Palliative Care (CAPC) estimated in 2014 that 6 million people across the country stand to benefit from receiving palliative care. Roughly 90 million people nationwide were living with a serious illness that year, a number anticipated to more than double during the next 25 years.

Hospice providers have struggled to fill their ranks as more staff reach retirement age amid ongoing and widespread workforce shortages. Roughly 10,000 people across the country reach the retirement age of 65 every day, according to the Kaiser Family Foundation. Research indicates that supply of a hospice and palliative care specialized workforce will be outpaced by demand, with shortages expected to worsen during the next 25 years.

The coronavirus pandemic has only further pressurized a shrinking workforce. Slightly more than 20% of health care workers have thought about leaving the field due to stress brought on by the pandemic, while 30% have considered reducing their hours, according to a recent study published in JAMA Network Open.

During the COVID-19 pandemic the need for quality palliative and hospice care has “only grown more pronounced,” according to Baldwin and Clarke, who stated that “hospitals have treated thousands of seriously-ill patients under extremely stressful circumstances, and patients and their families have faced incredibly difficult decisions, often without the necessary guidance or expertise of a palliative care team.”

PCHETA could make a significant difference if enacted, according to Rotella.

“We expect PCHETA to have a tremendous positive impact. There are not nearly enough of us to meet the true need,” Rotella told Hospice News. “The provisions in this bill not only would allow us to train more specialists, but also to train others who care for people with serious illness so that they can do some of this without having to use a specialist in dedicated palliative or hospice care programs.”

PCHETA also aims to increase public awareness about the benefits of palliative care. The act proposes the establishment of a national campaign to better inform health professionals, patients and their families. The campaign would drive forward palliative care resources, materials and information in a variety of publicly available formats. The legislation includes provisions that would direct the National Institute of Health to utilize authorities and funds to enhance and expand palliative research efforts aimed at improving care delivery for patients with serious or terminal illness.

Existing payment model programs have not valued or adequately reimbursed the full involvement of the palliative care team, Rotella told Hospice News.

Movement on a community-based palliative care benefit is in the works at a federal level. A group of U.S. senators in July introduced bipartisan legislation that would direct the Center for Medicare & Medicaid Innovation (CMMI) to develop a demonstration of a community-based palliative care payment and delivery model. The bill’s four co-sponsors are founding members of the Senate Comprehensive Care Caucus, which was established in 2019 to pursue legislation actions to raise awareness of palliative care, promote utilization, improve care coordination, support caregivers and expand access to services.

“If we can build up the workforce and have a payment mechanism that properly values palliative care and the treatment for people with serious illness, then we can see so many more people benefit from this great care,” Rotella said.

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