Date: January 13, 2017
To: Department of Public Health
From: Elissa Sherman, President, LeadingAge Massachusetts
Subject: Amendments to 105 CMR 141.000: Licensure of Hospice Programs
On behalf of LeadingAge Massachusetts, I am writing to submit comments on proposed Amendments to 105 CMR 141.000, Licensure of Hospice Programs. LeadingAge Massachusetts is a statewide association representing the continuum of not-for-profit providers of housing, health care and services for older adults including nursing and rehab facilities, residential care facilities (AKA rest homes), assisted living residences, continuing care retirement communities (CCRCs), subsidized senior housing and home and community based service providers including hospice programs. Our members provide housing and services to more than 25,000 older persons in the Commonwealth. Governed by community-based volunteer boards of directors, close to a quarter of our members, have been providing housing and services to elders in their communities for more than 100 years. Our vision is for all older adults to be able to live in age friendly communities which offer the services they need, when they need them, in the place they call home.
LeadingAge Massachusetts wishes to express our concern with the proposed amendment to 141.201 (D) which would require the hospice provider to maintain administrative records documenting initial and ongoing training on dementia care consistent with the requirements of 105 CMR 150.024 and 150.025 for employees providing direct care to nursing home residents. These provisions require 8 hours of orientation and 4 hours of ongoing training annually in specific topic areas as identified by DPH.
The definition of direct care worker, as identified in 105 CMR 150.001 (Definitions) includes “those workers employed by the nursing home, and shall include contracted workers who provide direct care to residents.” The definition further goes on to say that “office-based practitioners whose primary practice site is not the long-term care facility are exempt from the definition of direct care workers.” We believe that hospice workers who do not primarily work at the long term care facility, should not be subject to the dementia care training regulations of nursing facilities. These workers are not contracted by the facility, but instead they are working directly for the resident in a temporary capacity.
We do believe that all staff providing care to residents, whether they work in nursing facilities or other settings, should have the relevant skills needed to provide high-quality, compassionate care to those they are serving. However, we don’t believe that these specific provisions which were intended for those working primarily in nursing facilities should apply to hospice workers who are providing care to individuals in a variety of different settings with a range of conditions in which they must also be competent.
LeadingAge Massachusetts instead supports the recommendations of the Hospice and Palliative Care Federation of Massachusetts in regards to training requirements. Those proposed requirements more accurately reflect the specialized and interdisciplinary, end-of-life care provided by hospice workers.
Thank you very much for the opportunity to provide comments.