Impact of Nursing Shortage on Hospice Care: A New CMS Memo

In order to allow hospices affected by the shortage to utilize contracted nursing staff, the Centers for Medicare and Medicaid Services (CMS) has issued Impact of Nursing Shortage on Hospice Care, a memo that extended from Sept. 30, 2012, to Sept. 30, 2014, the "extraordinary circumstance" exemption for hospice.  

The move is in response to continued requests from providers that the current nursing shortage be designated as an "extraordinary circumstance." 

Hospices requesting this exemption must demonstrate that a training program is in place to assure that contracted staff are trained in the hospice philosophy and assure contracted staff are providing care consistent with this philosophy and the patient's plan of care.  

What's in the Memo

• The regulations allow a hospice to use contracted staff "…if the hospice can demonstrate that the nursing shortage is creating an extraordinary circumstance that prevents it from hiring an adequate number of nurses directly, to supplement hospice employees in order to meet the needs of patients during periods of peak patient loads."  
  
• The temporary measure of 'extraordinary circumstance' allows hospices to contract for nursing services - it does not extend to counseling services and medical social services,
  
• In order to qualify for an "extraordinary circumstance" exemption, a hospice must provide written notification to the State Survey Agency (SA) responsible for licensing and certification that it intends to elect an exception under the "extraordinary circumstance" authority. The hospice must estimate the number of nurses it believes it will need to employ under contract.
  
• Notifications through Sept. 30, 2014, should include:
  
  
  • An estimate of the number of patients that the agency has not been able to admit during the past three months due to the nursing shortage and the current and desired patient/nurse ratio for the agency.
    
    
  • Evidence that the hospice has made a good faith effort to hire and retain nurses, including: 
    • Copies of advertisements in local newspapers and Web postings that demonstrate recruitment efforts.
    • Copies of reports of telephone contacts with potential hires, professional schools and organizations, recruiting services, etc.;
    • Job descriptions for nurse employees.
    • Evidence that salary and benefits are competitive for the area.
    • Evidence of any other recruiting activities (e.g., recruiting efforts at health fairs, educational institutions, health care facilities, and contacts with nurses at other providers in the area).
• The hospice must demonstrate it has a training program in place to assure that contracted staff is trained in the hospice philosophy and the provision of palliative care prior to patient contact.
  
  
• The hospice must assure contracted staff is providing care consistent with the hospice philosophy and the patient's plan of care.
  
  
• Contracted nurses are used to supplement the hospice nurses employed directly and should not be used solely to provide the continuous nursing level of care or on call service.
  
  
• The hospice is expected to continue recruitment efforts during during the contract period.
  
  
• The SA will maintain copies of each exception notification and validate the hospice's stated need for an exemption during complaint and standard surveys.
  
  
• CMS will reevaluate the employment market for nurses during the summer of 2014 to determine if this policy should be further extended.