End of Life Resources & Information

Understanding and coping with end of life situations requires care and communication from Assisted Living providers, residents, and family members. Understanding a resident's wishes, and a resident understanding what's possible in Assisted Living are important to the ensured comfort of an individual at their end of life. CALA's end of life resources have been compiled below to make it easier for CALA members, as well as residents and their family members, understand the different aspects of this difficult time.

Hospice in Assisted Living

Hospice Regulations
In order to allow residents to stay in Assisted Living communities after they opt for hospice care, an Assisted Living community must have a hospice waiver in place from Community Care Licensing. In addition, licensing requires additional staff training and documentation in order for an Assisted Living community to retain residents on hospice. These regulations are addressed in Sections 87632 and 87633. Remember that CCL regulations do not reflect current law regarding hospice care in RCFEs. Implementation plans are available for information on when to call 911 for a resident on hospice as well as guidelines on admitting a resident who is currently on hospice.

Update! July 27, 2011 Total Care and Hospice—An Expedited Process
To streamline total care exception requests for hospice clients, CCLD has introduced a new optional process. Basically, licensees can provide much of the required total care exception information in the hospice waiver itself. Then, use the currently required hospice election notification to officially request the individual exception by referencing the already approved plan outlined in the hospice waiver. I can guess what you’re thinking (and I agree). The department was unable to create a process for a “hospice total care waiver” because the department cannot waive a prohibited condition. What we ended up with is not the comprehensive solution that CALA sought, but it does streamline the process somewhat.

If you want to give this process a try…

1. Amend the hospice waiver to include a plan that outlines how the needs of a total care resident will be met (87616(b)(2)) and how the impact on other residents will be minimized (87616(b)(3)).
2. When submitting the required notice that hospice has been initiation for a specific resident, the licensee can request an exception for total care at the same time and in advance of the resident actually needing total care. Two specific statements need to be included in the notification/exception request:
   • The individual resident’s hospice care plan, which is maintained at the facility, is a reasonable variance of Section 87616(b)(1), and
   • The granted Hospice Care Waiver is a reasonable variance of the requirements of Section 87616(b)(2) and (3).

This process is optional. The traditional process of obtaining a facility-wide hospice waiver and then applying for individual exceptions when a hospice client becomes total care remains unchanged. If you have any questions, please call Heather Harrison at 916-448-1900 or email hsh@CAassistedliving.org.

Access this section of the evaluator manual.

Hospice Checklist
Sometimes, it can feel like a challenge for Assisted Living providers and hospice providers to ensure these regulations are met. In order to help both providers navigate these requirements, CALA and CHAPCA (California Hospice and Palliative Care Association) developed an easy to use checklist. You can save this checklist to your computer, then fill it out and print it or you can print several to have on hand as needed.

FAQs

In order to further clarify their requirements for allowing residents who elect hospice to remain in Assisted Living, Community Care Licensing released answers to a list of Frequently Asked Questions, submitted to them by CALA. This list can be accessed here.

POLST

The Physician's Order for Life Sustaining Treatment (POLST) became a recognized document in the State of California in 2008. Since then, the Coalition for Compassionate Care, of which CALA is one of many participants, has been working to educate doctors, nurses, patients, and other health care professionals about the use of POLST. This document is designed to lay out what treatments a patient does and does not want in the event they are unable to express these wishes themselves. The document is a signed doctor's order, and follows the patient through whichever care settings he/she encounters. A sample of the form can be found here.

CALA developed a list of question and answers, in collaboration with the Coalition for Compassionate Care, in order to help Assisted Living providers understand POLSt and its role in Assisted Living communities. CALA members can access this Q&A here.

Other Organizations

For more information on hopsice and palliative care in California, we encourage you to reach out to CHAPCA. The California Hospice and Palliative Care Association works to promotes and strengthen the delivery of hospice care for terminally ill patients and their families through education and advocacy, according to their website. CALA and CHAPCA have worked closely to ensure providers receive education and continue to make resident's the first priority.

The Coalition for Compassionate Care is a statewide partnership of more than 95 regional and statewide organizations promoting high-quality, compassionate end-of-life care for all Californians. In 2008 the coalition worked to pass AB 3000 (POLST) recognizing the use of the Physician's Order for Life Sustaining Treatment in the state of California. They are working on the statewide distribution and use of POLST in the field, and have additional resources for Advanced Health Care planning.