Knowing when to choose hospice care is a challenge; that's highlighted by Rosalynn and Jimmy Carter's end-of-life journey

National Institute on Aging infographic

"The death of former first lady Rosalynn Carter on Sunday, and the survival of her husband, former president Jimmy Carter, have exposed one of the most achingly difficult questions faced by people with life-threatening illness: when to choose hospice care," Lenny Bernstein and Dan Keating report for The Washington Post.

Carter, who was 96, died two days after entering hospice. Jimmy Carter entered hospice in February at the age of 98, outlasting the six-month prediction of life that is typical of people when they enter hospice care. 

Rosalynn Carter (2005 Associated Press photo by Ric Feld)

Rosalynn Carter had a urinary-tract infection that was not responding to antibiotics when she entered hospice, which experts told the Post is among the many reasons people with dementia might switch to hospice care late in the course of the disease. 

Bernstein and Keating report that many people follow the same path. 

" About half of all people are in hospice at the end of their lives, but more than 25% of hospice patients enroll in the final week, according to 2021 data from the Medicare Payment Advisory Commission, which advises Congress on Medicare issues," they write. 

Others among the 1.7 million Medicare patients who used hospice that year used the service much longer, they report, with a median stay of 17 days and ab average stay of 92 days, "which shows that some patients were in hospice for many months."

Angela Novas, senior medical officer for the Hospice Foundation of America, a nonprofit organization, told the Post that Rosalynn Carter’s experience is not uncommon.

“When people are that age and have a chronic condition like dementia that is progressing, and progressing slowly, there comes a turning point where suddenly the symptoms accelerate exponentially,” Novas said.

Doctors also play a role in delays in enrolling because of "difficulty prognosticating" and patients often wait, hoping for a final experimental treatment to become available, Mamta Bhatnagar a University of Pittsburgh Medical Center physician who specializes in hospice and palliative care, told the Post.

The first U.S. hospice opened in Connecticut 49 years ago, but there is still considerable confusion about end-of-life care options, caregivers and experts told the Post. 

"People who choose hospice agree to give up therapeutic efforts to prolong their lives and focus on comfort and quality of life. Two physicians must attest that the patient has six months or less to live. The period can be extended, and patients can change their minds about being in hospice at any time," the writers report. "Hospice is most often provided at home, but “home” can be a nursing facility, a hospital or a free-standing hospice center, among others. The latter are increasingly run by for-profit companies but also are operated by nonprofits." 

In contrast, “palliative care” or "comfort care" aims to make patients more comfortable and ease stress but can be done while doctors are still seeking to cure a disease. 

Added to the confusion, the authors write that sometimes life-prolonging and palliative therapies can overlap, such as the use of diuretics for people with heart failure or radiation to relieve pain by shrinking a tumor. 

Myths and fears about hospice still abound, Joan Teno, a Brown University hospice physician and researcher, told the Post.

"Doctors and advocates said they still hear from patients that hospices are where patients are killed off, usually because of the use of morphine to relieve pain in end-of-life care. Others think that the hospice team will take over completely and that family can leave the responsibilities of caregiving to them," the authors write. 

“There’s very few people who say, ‘I wish I had started hospice later,’” Ben Marcantonio, interim CEO of the National Hospice and Palliative Care Organization, told the Post.

End-of-the-year holidays produce a surge in calls about hospice when families gather and physical and mental decline can become apparent, Novas told the Post. The Carters have provided a lesson in what to do next.

“The Carters are doing a fantastic job in continuing to educate us,” Novas said. “Throughout their lives, and now in their deaths, their legacy will be teaching us about mental health and how to live and how to die well.”

People seeking advice about hospice can contact the Hospice Foundation of America’s Ask an Expert service at https://hospicefoundation.org/Ask-HFA [hospicefoundation.org] or by calling 202-457-5811 or 800-854-3402. 

The Kentucky Association of Hospice and Palliative Care can be reached at 888-322-7317 or found online at kahpc.org. 

Most people have end-of-life wishes, but don't talk about it; planning for death is less likely in rural areas, study finds

St. David's Foundation graph; click on it to enlarge.

As America ages, more families face end-of-life decisions, and rural Americans are less likely to have their wishes known or followed by family members, reports Liz Carey of The Daily Yonder. "A new study found that while most people have end-of-life wishes, only a little over a third of them actually get them fulfilled. That is even more true with rural residents, researchers said."

Researchers from St. David's Foundation in Texas found that when it comes to end-of-life care, most Texans want to die at home (76%) and not be a burden to their families (77%). "But only one in three people surveyed said their loved one's wishes were honored," Carey writes. "Of those who are least likely to have their end-of-life wishes followed are rural residents, the study found. . . . Only 37% of the survey respondents said their loved ones died at home. Close to half of them (47%) said their loved one faced challenges related to their care – from problems with insurance coverage to facing cultural or language barriers."

Honoring a person's wishes begins with knowing what they are. Andrew Levack, senior program officer with St. David's Foundation, told Carey: "One of the interesting things the study found was how few conversations respondents had with their doctors around plans for end of life. I think people have an idea of what they would like, but it takes some active planning and advocacy to make that happen."

Study researchers noted a common thread of disconnection across the state -- people have end-of-life care desires, but don't voice them. "Most Texans, even older adults, are unprepared for decisions about end-of-life care. The vast majority believe it is important to have their wishes in writing, yet over half have not done so. Similarly, many say they would like to discuss end-of-life planning with their health care provider if they were faced with a serious illness, yet only 17% have had a provider initiate a conversation about it."

Geographical isolation and a lack of health care access make rural populations more likely to not have end-of-life plans or discussions. Dr. Kate Tindell, medical director for Austin Palliative Care and Hospice, told Carey: "People have really disjointed health care now. We've sort of lost that sense that there is a captain of the medical ship who is aware of all the moving parts and is giving the patient that guidance. I think that really causes people to not have the kind of relationship that would allow them to have that kind of conversation (about end-of-life wishes) the way they would if they had seen the same provider every single time for 10 years."

Libertarians want to repeal 'certificate of need' permit process for health-care facilities; they say it needs reform, not repeal

Kentucky Health News

Should Kentucky have a permitting process for health-care facilities or allow free-market competition? Or something in between? The General Assembly has begun debating the question, amid lobbying from a national libertarian group and health-care facilities that say unfettered competition would further complicate heath care and put some of them out of business.

When stand-alone birthing centers wanted an exemption from the state's "certificate of need" law this year, the legislature said no, but created a task force to examine the law and how it works. The task force heard July 17 from lobbies for hospitals, nursing homes home-health services and hospices, who think the law should be improved but not repealed, Sarah Ladd reports for the Kentucky Lantern. (This article is based mainly on her story.)

Nancy Galvagni

Without certificate of need, some facilities could close or stop offering services that don't make money, Kentucky Hospital Association President Nancy Galvagni told the task force. She said most services “are provided at a loss and must be subsidized by the few services from which hospitals derive revenue, such as elective surgery and . . . outpatient imaging. This is how hospitals pay for services such as behavioral health, obstetrics, emergency care, trauma care, and oncology, just to name a few.”

Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”

Tim Veno, president of Leading Age Kentucky, a lobby for nonprofits that provide aging services, told lawmakers that “over-duplication of health services can have multiple negative effects” on nursing homes. Too many nursing-home beds in an area could cause a home to close, or make staffing challenges worse, he said.

Home-health services also have staffing issues the inability to compete with hourly wages offered by places like Amazon and Target, said Evan Reinhardt, executive director of the Kentucky Home Care Association.

Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.

The week before the task force met, Americans For Prosperity promoted repeal of the certificate-of-need law at an event in Northern Kentucky. AFP is one of the groups funded by energy mangnate Charles Koch of Wichita, known for his spending on libertarian, conservative and Republican causes.

"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY (republished in the Kentucky Lantern).

AFP says it recently got the process repealed in South Carolina after 10 years of lobbying. "Kentucky is one of 35 states and the District of Columbia that operate certificate-of-need programs, which vary widely among the states, according to the National Conference of State Legislatures," Payne reports.

State Rep. Marianne Proctor

One speaker at the Northern Kentucky event was state Rep. Marianne Proctor, R-Union, who has field a bill to repeal certificate of need for Boone, Kenton and Campbell counties.

“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”

The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:

• Reform the application and appeals process to save time, allowing providers to apply at any time, and have shorter hearings.
• In formal-review cases, require written statements saying why an application shouod be rejected.
• In expedited-review cases, limit challenges to the issue of need and whether the applicant qualifies for expedited review.
• Allow hospitals to provide services at an additional location in the same county without an additional certificate.
• Allow hospitals to get expedited review for converting beds to adult psychiatric care if the county has no such hospital.

The next meeting of the task force is scheduled for 10:30 a.m. Aug. 21. It is seeking public input by Sept. 1; to submit a written statement, email DeeAnn Wenk at deeann.wenk@lrc.ky.gov.

Quarles says that if elected governor, he would work with the General Assembly to legalize medical marijuana in Kentucky

Quarles spoke on the Capitol steps. (KL photo by McKenna Horsley)

By McKenna Horsley
Kentucky Lantern

Agriculture Commissioner Ryan Quarles told reporters Tuesday he would work with the General Assembly to legalize medical marijuana if he is elected governor.

“It needs to be dialogue between a doctor and their patient, and keep big government out of it,” Quarles said, adding that patients in end-of-life care could benefit from medical marijuana, and some are already self-medicating.

Quarles touted his experience running Kentucky’s hemp-licensing program in his seven-plus years leading the state Department of Agriculture. He criticized Democratic Gov. Andy Beshear’s executive order on medical marijuana, saying it “muddied the water on this issue” and failed to involve Kentucky agriculture.

 
He said provisions should be made to benefit production from Kentucky farmers, including those who already grow hemp, and medical marijuana should, like other medications, be exempt from sales tax.

Beshear has said that 90% of adult Kentuckians support legalizing medical cannabis. His executive order, which took effect Jan. 1, set criteria for Kentuckians with certain medical conditions to access medical cannabis in small amounts through legal out-of-state purchases.

Quarles said that because the General Assembly was bypassed in implementing the order, doctors and patients are confused.

“As a former legislator, I feel like I have the ability to work with the General Assembly and not sue them constantly like the current governor is doing,” he said. The legislature is controlled by fellow Republicans.

When asked how he plans to get legislation like this through the Senate — where bills to legalize medical marijuana have failed in recent years — Quarles said he’s worked to get other pieces of legislation passed and will approach it with the attitude of “consensus-driven” policy-making.

“I believe that over the course of the next year, we can find common ground that gets something that works for Kentucky and again is focused on that doctor-patient relationship,” Quarles said.

Bills to legalize medical marijuana have been filed in the current legislative session, such as Senate Bill 47 from Sen. Stephen West, R-Paris.

Asked about recreational marijuana, Quarles said Tuesday’s press conference would focus only on medical use. He said products with Delta-8 tetrahydrocannabinol — a psychoactive ingredient similar to delta-9 THC, the active ingredient specified by federal law — should be regulated. 

Quarles said none of the other candidates are “better positioned in this race to have a conversation about what the framework would be like to help pass a responsible medical marijuana bill through the General Assembly,” but in response to a question about how this issue sets him apart from the field, he said that he’s not focused on other campaigns, only his.

“Look, there’s 12 of us in this crowded primary,” he said. “All of them are my friends. They’re going to be my friends after May 16.”

The field includes Attorney General Daniel Cameron and former United Nations Ambassador Kelly Craft. Their campaigns have not responded to email questions from Kentucky Lantern about their positions on medical and recreational marijuana.

Somerset Mayor Alan Keck, another Republican running for governor, told the Bowling Green Daily News in January that medical marijuana is “a ‘common-sense solution’ for things like pain management, insomnia in veterans and children who suffer from seizures.”

KET program, airing Monday night and online afterward, explores how to die a better death, with a focus on palliative care

The World Health Organization describes palliative care as

"an approach that improves the quality of life of patients and

their families facing the problems associated with life-threatening

illness, through the prevention and relief of suffering by means of

early identification and impeccable assessment and treatment of

pain and other problems, physical, psychosocial, and spiritual."

A Kentucky Educational Television program will examine some moral questions surrounding death, including how to approach medical treatment when you are at the end of your life. 

The program "Horizon: How to Die a Better Death," is presented by Dr. Kevin Fong, who explores what it means to die a better death and shows how palliative care, when done right, can help individuals achieve that goal by shifting the focus from cure to care.   

Fong talks to medical professionals and people who are near the end of their lives and explores how individuals should approach medical treatment when they are dying.

The documentary will air at at 9 p.m. ET and 8 p.m. CT Monday, June 21; and 4/3 p.m. Thursday, June 24 and Sunday, June 27 at 4/3 p.m. KET program are also available at www.ket.org.

Sham charity in Nashville, caught in 7-state probe prompted by tip from Maysville hospice, agrees to dissolve, pay costs and fines

A tip from a hospice employee in Maysville led Kentucky's attorney general and those in seven other states to shut down a sham charity that said it was for the benefit of local hospices.

The New Hope Foundation Inc. of Nashville agreed to dissolve, and three of its officers will "be banned from any charity or fundraising activities in perpetuity," said a news release from Attorney General Andy Beshear. "New Hope agreed to repay the cost of the investigation and pay more than $74,000 in civil penalties to the states, which were calculated based on an even split and money made in each state. Kentucky’s general fund will receive more than $6,000."

The release explained, "New Hope raised funds through telemarketing and direct mail and allegedly provided education regarding hospice services. It sent 'local area appeals' which appeared to donors to be solicitations from their local hospice providers but were not."

The case "began when Michael Parker, director of public relations and development of Hospice of Hope in Maysville, made a report" to Beshear's office, the release said. "Parker reported that Hospice of Hope is the only hospice service provider in the Maysville area and its donors were receiving solicitations from the Hospice Support Fund for a “Maysville Area Appeal” and those donors were confused. The Hospice Support Fund was a program of New Hope, but Hospice for Hope did not receive any money from this solicitation or from New Hope in general."

Senate health panel OKs 4 opioid bills; 3 quickly pass Senate

By Melissa Patrick
Kentucky Health News

Four of the seven bills that passed out of the March 14 Senate Health and Welfare Committee meeting dealt with opioids, and three of them have already passed out of the Senate.

A bill for safe disposal of unused opioids passed quickly out of the committee by a 9-1 vote and passed the full Senate later the same day on a vote of 34-2.  It now goes to the House.

Senate Bill 6 had been pulled off the floor and sent back to committee March 13, prompting sponsor Alice Forgy Kerr, R-Lexington, to say it was delayed in retaliation for her refusal to vote for the controversial public-pension bill. Senate leaders told Deborah Yetter of the Louisville Courier Journal that the bill needed a "technical revision."

The bill would require pharmacists to inform customers about how to safely dispose of unused opioids and other controlled substances, and offer to sell them a product designed to neutralize drugs for disposal. The committee added fines of $25 for a first offense, $100 for a second violation and $200 for each subsequent violation and a provision that Medicaid would not pay for the disposal aid.

Sen. Stephen Meredith, R-Leitchfield, cast the only no vote in committee. He said he supported the idea but had too many concerns about who would bear that cost. He also voted no on the Senate floor, along with Sen. Wil Schroder, R-Wilder.

Explaining his yes vote, Sen. Reginald Thomas, D-Lexington, said, "This is something that we need to move on. Something that we should not play politics with because the people who are affected don't care about Republicans and Democrats." Thomas is running for Congress.

Rep. Addia Wuchner, chair of the House Health and Family Services Committee, saw two of her opioid bills pass out of the Senate committee, and one of them is awaiting posting for House concurrence in a Senate amendment.

House Bill 148 would shift ownership of controlled substances from a deceased hospice patient to the hospice program for disposal. Such drugs now go to estates.

The bill would require hospice and other palliative-care agencies to have written policies and procedures for getting rid of certain painkillers upon the death of the patient. The policy would be reviewed with patients and their families, who would then be asked to agree to the policy in writing. The disposal of the drugs would be completed by the agency or the person pronouncing death and would be witnessed by an adult, who would sign a statement to the fact.

Families who do not agree would be reported to the local health department or local law enforcement.

Wuchner, R-Florence, told the committee that the bill is not meant to threaten families at a time of loss, but to stress the importance of the need to destroy the drugs. It went to the Senate floor without dissent.

House Bill 124 unanimously passed the health committee and the full Senate. It calls for a comprehensive review of all state programs for substance-use disorders, and would require the state to only pay for and license ones that follow nationally recognized, evidence-based protocols.

The Senate added an amendment to allow the Department of Corrections to purchase long-acting, medication-assisted treatment products for substance-use disorders that are resistant to diversion, including unspecified new ones not yet available.

Senate Bill 250 also unanimously passed out of the health committee and the full Senate and will now move to the House. It would require all pregnant women to be tested for hepatitis C, with the results added to the child’s records. It also recommends that the child be tested at 24 months if the mother tests positive. Hepatitis C can be transmitted from mother to baby during childbirth.

Riggs Lewis, system vice president of heath policy at Norton Healthcare, stressed the importance of screening every pregnant woman in order to be able to treat both the mother and baby. He noted that most new cases of hepatitis C are a result of illegal intravenous drug use, so cases are expected to increase. "This is going to be a shadow that follows the opioid epidemic," he said.

Bill headed to full House would require hospice patients' narcotics to be turned in upon death

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill aimed at fighting Kentucky's opioid epidemic would require families who using hospice-type services to turn in their deceased family member's unused narcotics or be reported to police or the health department.

The Health and Family Services Committee sent House Bill 148 to the full House on a unanimous vote Feb. 1. Committee Chair Addia Wuchner, R-Florence, who is co-sponsoring the bill with Rep. Kim Moser, R-Taylor Mill, said it is important for Hospice patients to have access to these "powerful medications" for pain, but said they need to be disposed of properly at the time of death.

"We're all aware of the opioid crisis and situation that we have in the Commonwealth of Kentucky," Wuchner said. "And the aim of this bill, and we'll probably see other measures of legislation this session, is to also prevent those drugs from . . . being diverted on to the street, or into unwanted hands for use."

The bill would require hospice and other palliative-care agencies to have written policies and procedures for getting rid of certain painkillers upon the death of patients.

The policy would be reviewed with patients and their families, who would then be asked to agree to it in writing. Wuchner called it a "contract." The bill says that if a patient or representative refuses to agree to the "deactivation or sequestration and disposal" of the drugs upon death, "local law enforcement or the Department for Public Health shall be notified of the refusal."

The disposal of the drugs would be completed by the agency or the person pronouncing death and would be witnessed by an adult, who would sign a statement to the fact.

Wuchner said federal law makes any medicine prescribed to a patient part of the estate, but it also allows states to adopt laws like the one proposed.

Amelia McClure, government affairs liaison at Hosparus Health, which she said serves 7,800 patients a year in 37 Kentucky and Indiana counties, spoke in support of the bill.

"It is a stark reality that the opiates are destroying lives across our state and more measures must be taken to get ahead of the emergency," McClure said. "House Bill 148 will assure that hospices continue to handle these prescriptions with responsibility and that when patients pass on they do not leave behind a potentially dangerous legacy."

Louisville senator hopes third time is charm for his bill to allow marijuana to be used to alleviate suffering of the terminally ill

Kentucky should join the states that have authorized marijuana for medical use, and allow it to be used to relieve suffering of the terminally ill, a Democratic legislator from Louisville told a House-Senate committee Wednesday.

McGarvey after the meeting (C-J photo by Deborah Yetter)

"It's 2017," Sen. Morgan McGarvey told the Health and Welfare Committee. "I think it's time we had a conversation about medical marijuana without snickering."

"Members of the committee took no action on legislation McGarvey is proposing for the 2018 legislative session, but no one spoke against the proposal and some committee members spoke in favor of the measure that went nowhere in the past two legislative sessions," Deborah Yetter reports for The Courier-Journal, quoting Sen. Tom Buford, R-Nicholasville: "This is an issue that's got to be dealt with some way."

McGarvey, who has "sponsored similar, unsuccessful measures in the last two sessions of the General Assembly," said public attitudes are moving toward medical marijuana "in some circumstances," Yetter reports. "And he said he doesn't believe support breaks down on partisan lines."

"Everyone has someone in their life who has suffered from cancer or a debilitating illness," McGarvey said. "What we're hearing from Democrats and Republicans is that we need to provide some relief."

McGarvey told the panel that 26 states already allow medical use of marijuana "and said he sees no reason Kentucky should wait any longer," Yetter reports. McGarvey said,"If you're last, you're last and Kentucky shouldn't be the last state to do this." He said it would not be a "back door" to recreational use of marijuana, as some states have done. "That's an argument made out of fear and not out of fact," he said. "It's not a back door to anything."

Yetter writes, "Several supporters of medical marijuana who attended the hearing said they don't think McGarvey's bill goes far enough, that it should allow broader medical use than just for those who are terminally ill. Among them was Dr. Don Stacy, a Louisville cancer doctor who said he has seen dramatic improvements in patients who acknowledge using marijuana 'behind closed doors' to ease pain and nausea from treatments including chemotherapy and radiation."

Nursing homes and other elderly caregivers will have to do national, fingerprint-based background checks on employees

Nursing homes and many other health care providers will be required to obtain national criminal background checks on new employees and others who provide direct one-on-one care to elderly residents or patients, under an emergency regulation outgoing Democratic Gov. Steve Beshear issued Friday.

Besides nursing homes, which have been the focus of concern about elder abuse, the regulation also applies to personal-care homes, intermediate care facilities, adult day health-care programs, assisted living communities, home health agencies, hospices, personal-services agencies, providers of home and community-based services, and staffing agencies, "including nursing pools that have contracts to provide staff to one or more of the listed employer types," a state news release said.

Only 7 percent of those providers are using a voluntary system to do national, fingerprint-supported background checks, Cabinet for Health and Family Services spokeswoman Beth Fisher told Kentucky Health News.

“Protecting the elderly and other individuals residing in these facilities is not only important – it is our duty as state leaders,” Beshear said in the release. “All too often, these vulnerable citizens become victims of the very individuals who are supposed to be caring for them. This regulation, based upon a federal law allowing these background checks, will ensure we are able to thoroughly track the history of anyone who has committed such an offense, whether it occurred in Kentucky or out of state, and ensure they will not be working at health care facilities in the commonwealth.”

State law requires only name-based, Kentucky-specific background checks, "creating a loophole that allowed applicants seeking employment in these long-term care and other settings to hide criminal actions committed in other states," the release said. "Meanwhile, the prevalence of alleged abuse or exploitation of seniors in these settings remained significant."

The release said that since May 2014, over 2,600 complaints have been filed against long-term care providers, almost 30 percent directly related to suspected abuse or exploitation of residents. Requiring fingerprint-supported background checks means that "applicants will not be able to hide criminal actions committed in other states," Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said in the release. "National background checks are a critical initiative that dramatically improve the ability of long-term care and other providers to timely and accurately research the backgrounds of potential employees, ruling out individuals with histories of violence, abuse or exploitation that occurred in other states."

The state has operated a fingerprint-supported vetting program since 2011, using federal grants. “This program . . . has now been fully tested by voluntary participants over the last 18 months, and the feedback has been overwhelmingly positive regarding its ease of use, cost effectiveness and speed,” CHFS Inspector General Maryellen Mynear said in the release. “Our office will assist providers as they apply for initial licensure or renew their existing license to ensure a smooth and timely transition to a national criminal background check program that meets the requirements of this regulation.”

The program usually returns results in 24 to 72 hours, compared to three or more weeks using the traditional, paper-based process, the release said. However, only 85 of the 1,267 providers who will be covered by the new rule use the voluntary program, CHFS spokeswoman Beth Fisher said.

Because the rule is in an emergency regulation, Republican Matt Bevin could revoke it after he becomes governor Dec. 8, but Beshear's news release quoted Republican state Sen. Tom Buford of Nicholasville as saying,  “I commend Gov. Steve Beshear for this action to provide protections for our senior citizens.”

State Rep. Linda Belcher, D-Shepherdsville, said in the release, “I have been working on legislation to accomplish this for some time now and am very pleased Gov. Beshear has taken this step to further protect the elderly residents and patients.”

The release said the voluntary program "has performed more than 2,200 background checks and has screened out applicants who had been convicted of serious violent offenses in other states but had no criminal history in Kentucky." The program’s website, http://chfs.ky.gov/os/oig/kares, contains provider enrollment information, general information for both providers and the public, frequently asked questions and links to related programs and content. Additional information is available via email to KARES.Helpdesk@ky.gov or by calling 502-564-2159.

Panel OKs new medical-order form that would clearly define a person's end-of-life wishes on nutrition, hydration, medication

A bill to create a medical order form that details a person's wishes for end-of-life care passed the Senate Health and Welfare Committee Feb. 4 and seems headed for passage in the full Senate.

Advocates say that while many physicians discuss end-of-life care with their patients and families and document it, this information is often buried deep in the chart and is not easily accessible in an emergency situation.

"This issue comes to play on a daily basis," Christian Furman, vice-chair of geriatric medicine at the University of Louisville and medical director of two nursing homes in Louisville, told the committee.

Sen. Tom Buford

Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, would creates a new Medical Order for Scope of Treatment form to specifically direct the type of treatment a patient would like to have and how much medical intervention they would like to have during end-of-life care. The MOST form is used in 32 states, Furman said.

The form is more detailed than a living will because it addresses not only the question of resuscitation, but specifies which life-saving measures, such as nutrition, hydration and medication, that a person wants to receive and under what circumstances.

The form must be reviewed annually. It allows for information sharing between providers and is part of the patient's electronic health record.

Furman said the order of controlling documents for end-of-life care is clearly defined in the bill: the living will first, the MOST form second, and the health-care surrogate, which is chosen by the patient and listed on the form, third.

Sen. Ralph Alvarado, R-Winchester, who is a physician, told his fellow committee members that the MOST form will not only assure a person's personal wishes are honored, but will also save an "immense" amount of money "just in terms of doing unnecessary treatments for folks."

"Five percent of Medicare beneficiaries die each year and their end-of-life care accounts for about 30 percent of total Medicare spending with as much as one-third spent in the last month of life," Bill First writes for Morning Consult, citing an article from the peer-reviewed journal Health Affairs.

Sen. Reggie Thomas, D-Lexington, a lawyer, said the medical community and patients need to be made aware that such forms exist. Buford said he trusted this would happen.

Hospice firms drain billions from Medicare by taking patients who aren't actually dying, Washington Post discovers

http://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html

Cost is one obstacle for bill that would require coroners to look into nursing home deaths

A bill that would require coroners to be called when someone dies in a nursing home may be in jeopardy. At issue is how to pay for it.

Chief State Medical Examiner Tracey Corey estimates she would need three more doctors, more support staff and more equipment if even 10 percent of deaths needed investigation, the Lexington Herald-Leader's Valarie Honeycutt-Spears reports.

House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, right, would require a nursing home or hospice staff member to alert a coroner about a death on the premises within 24 hours. If they, and they alone, suspect abuse, coroners would be required to inform law enforcement authorities or prosecutors. The aim is to determine if abuse or neglect might have occurred.

"But Burch said if Corey's financial concerns lead to the bill being sent to the committee making decisions about state spending, he think it 'means sudden death' for the legislation," Honeycutt-Spears reports.

Burch also said nursing home officials are balking at the bill's aim to increase the penalties for failing to report abuse or neglect. As of now, such a failure is considered a Class B misdemeanor, which carries a punishment of up to 90 days in jail and a $250 fine. The bill would change it to a Class A misdemeanor, which can result in up to 12 months in jail and a fine up to $500.

The bill would also mean long-term care facilities that fail to designate a staff member to report deaths to the coroner would be fined $200 a week. (Read more)

Federal grant will help build assisted-living and hospice facility in Maysville

Gov. Steve Beshear presented a $800,000 community development block grant (federal money administered by the states) for the construction of a Maysville assisted-living facility and hospice inpatient facility Friday, The Ledger Independent reports.

The Hospice of Hope projects will include 32 apartment-style units in the assisted-living facility, and eight units for hospice care. The $7- to $8-million project is slated for construction this spring.

At the check presentation, Beshear said Kentuckians are finding ways to improve health care-related services, despite tough economic times. Beshear spoke of his administration's efforts to increase enrollment in KCHIP, a free or low cost health insurance program for children, and the efforts to secure $62 million for the Kentucky Prescription Assistance Program. (Read more)