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1745-1746

HEALTH AND SAFETY CODE
SECTION 1745-1746

1745.  (a) The purposes of this chapter are to provide for the
licensure of hospices by the state department in order to ensure the
health and safety of patients, who by definition, are experiencing
the last phases of life due to the existence of a terminal disease,
and to permit qualified persons, political subdivisions of the state,
and governmental agencies to comply with requirements of federal law
regarding the provision of hospice care.
   (b) In enacting this chapter, it is the intent of the Legislature
to allow all qualified persons, political subdivisions of the state,
and governmental agencies to provide hospice services to the people
of California. It is also the intent of the Legislature to
distinguish between the functions of a volunteer hospice and a
hospice requiring licensure. It is further the intent of the
Legislature to require the state department to establish standards of
quality care for licensed hospices.
   (c) It is the intent of the Legislature that regulations adopted
by the state department pursuant to this chapter not be so burdensome
or costly, or both, in terms of implementation, that hospices
located in rural areas are forced to stop providing care. Therefore,
the state department shall exercise discretion and program
flexibility in regard to licensing hospices which are located in
rural areas of the state.



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) "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, but does not
provide for efforts to cure the disease.
   (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.
   (c) "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.
   (d) "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 physicians and surgeons in the community.
   (e) "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.
   (f) "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 program. The hospice
shall retain overall responsibility for the development and
maintenance of the plan of care and quality of services delivered.
   (g) "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.
   (h) "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.
   (i) "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.
   (j) "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.
   (k) "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.
   (l) "Home health aide" has the same meaning as set forth in
subdivision (c) of Section 1727.
   (m) "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.
   (n) "Parent agency" means the part of the hospice that is licensed
pursuant to this chapter and that develops and maintains
administrative controls of multiple locations. All services provided
by the multiple locations and parent agency are the responsibility of
the parent agency.
   (o) "Palliative" refers to medical treatment, interdisciplinary
care, or consultation provided to the patient or family members, or
both, that have as its primary purposes preventing or relieving
suffering and enhancing the quality of life, rather than curing the
disease, as described in subdivision (b) of Section 1339.31, of a
patient who has an end-stage medical condition.
   (p) "Preliminary services" means those services authorized
pursuant to subdivision (d) of Section 1749.