The Pennsylvania state Senate has approved a bill proposing to expand staffing requirements around death proclamations to include a wider breadth of hospice clinicians.
If enacted, the legislation would allow licensed practical nurses (LPNs) providing hospice care to make death pronouncements. Death pronouncement requirements in the state are currently limited to professional registered nurses (RNs), medical doctors, physician assistants and coroners under the Vital Statistics Law of 1953.
Recently introduced by state Sen. Lynda Schlegel Culver (R), the bill is currently in review by the state House of Representatives’ Health Committee. The legislation comes at a time when health care delivery costs are rising alongside labor pressures, according to Culver.
“Requiring a doctor, RN, physician assistant or coroner to make a death pronouncement when an LPN easily could fulfill that function can be costly,” Culver said in a statement. “LPNs provide care up until the moment of death, but when the patient dies the LPN lacks the authority to make a death pronouncement.”
The legislation was rolled out with greater recognition around the prolific workforce shortages hospice providers are facing, according to Culver. Giving LPNs the authority to make death pronouncements could help hospices to better allocate their resources, Culver stated.
Similar to national trends, demand for hospice in Pennsylvania is outpacing the growth of interdisciplinary professionals to provide it.
Roughly 73,963 Medicare decedents utilized hospice in Pennsylvania in 2021, which falls in the middle in utilization among the states, according to the U.S. Centers for Medicare & medicaid Services (CMS). Hospice utilization ran highest in California and Florida that year at 156,000 and 154,521 decedents, respectively.
The number of hospice providers in Pennsylvania dropped by 4.7% between 2017 and 2019, with a greater decrease among rural communities compared to urban areas, according to a report from The Center for Rural Pennsylvania. Many rural-based regions in the state only have one hospice organization serving several counties, often facing staffing shortages, increasing demand and higher travel costs, the report indicated.
Seniors 65 and older represent 20% of Pennsylvania’s overall population, according to the U.S. Census Bureau.
This aging population will reach the end of their lives in various community- and facility-based settings in which hospice care is available, according to Culver. Having LPNs available to assist with death announcements could help improve quality outcomes among families, Culver indicated.
“LPNs provide quality and essential care during a highly emotional time for patients and their families,” Culver said. “LPNs in hospice settings provide end-of-life care to patients in the weeks and months before they pass away.”
