Senate Again Takes Up Hospice, Palliative Staffing Bill

Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (R-W.Va.) have reintroduced the Palliative Care and Hospice Education Training Act (PCHETA), designed to bolster the field’s shrinking workforce with federal support.

If enacted, PCHETA would support hospice and palliative care training programs for physicians, nurses, pharmacists, social workers and chaplains. The bill would also expand continuing education and career development programs and incentives in these fields.

“Access to high quality palliative and hospice care services is vital for patients and their families,” Capito said in a statement. “As a caregiver for parents living with Alzheimer’s disease, I saw firsthand just how valuable these services are. In order to preserve access to this care, our bill would strengthen training and education opportunities for individuals working in these fields.”


The legislation would establish fellowships through new palliative care and hospice education centers to provide short-term, intensive training, as well as incentivized award programs across all the relevant disciplines. It includes provisions for additional training for medical school faculty and other health care educators, as well as provider resources for workforce development and nurse retention projects. 

Beyond the staffing issue itself, PCHETA would also create new avenues for raising public awareness of hospice and palliative care.

Thus far, eight other senators have signed on to co-sponsor the bill, which received endorsements from more than 50 industry organizations. These include the National Hospice and Palliative Care Organization (NHPCO), Hospice Action Network, Hospice and Palliative Nurses Association, the National Association for Home Care & Hospice (NAHC), and the American Academy of Hospice and Palliative Medicine, among many others.


“The COVID-19 crisis has reminded us all that the compassionate and holistic services embodied by hospice and palliative care are not a nice-to have — they are a must-have,” NAHC President William Dombi said in a statement. “PCHETA is transformative legislation and would go a long way towards ensuring there are more providers capable of delivering this care across all settings, including and especially patients’ own homes and communities.”

The long-standing hospice and palliative care workforce shortage has worsened substantially during the pandemic. Many in the space see the labor issue as the greatest threat to not only their businesses but to access to care for patients and families.

Reintroduction of the bill is a positive step for providers seeking relief from labor pressures, but the programs the legislation proposes may have a long road ahead.

This is the latest of several attempts to move PCHETA through Congress. The House of Representatives passed the bill in Oct. 2019 only to see it flounder in the Senate. And even if the bill does reach the White House for signature, additional legislative action would be necessary to appropriate the necessary funds.

But the need is great.

Most medical, nursing, pharmacy and social work students receive little exposure to hospice or palliative care during their training. A 2018 study showed that most students in clinical disciplines do not feel prepared to provide family care at the end of life.

Without widespread change, the demand for palliative care will likely outstrip the supply of the clinicians trained to provide it during the next decade.

While PCHETA would be an important step towards that change, the journey would not end there, according to NHPCO President and CEO Edo Banach. 

Banach called not only for PCHETA to pass, but for permanent implementation of temporary flexibilities for telehealth instituted during the COVID-19 public health emergency.

He also cited immigration reform as a means to widen the labor pool.

“PCHETA and providing for more education and more money is going to help address the problem going forward, but it’s going to take a lot more than that. There are things that can be done through technology, especially in rural areas.” Banach said at the Hospice News Palliative Care Conference in Chicago. “And there are a lot of people in a lot of other places that would love to come here at work, and we do need comprehensive immigration reform to make that happen.”

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