Hospices Have High Hopes for PCHETA, But Is It Enough?

Hospice stakeholders are optimistic that Congress will pass the recently reinstated Palliative Care and Hospice Education Training Act (PCHETA). While some see the bill as a beacon of hope, lasting change will likely require more than a single law.

Legislation has trickled through without passage in the last five years, but COVID may have opened lawmakers’ eyes to the value of hospice and palliative care and a “huge gap” between the demand for that care and the supply of qualified staff to provide it, said Davis Baird, director of nursing home management affairs at the National Association of Home Care & Hospice (NAHC).

“[PCHETA] was badly needed when it was first introduced and is needed even more now. The excess death, serious illness and associated suffering caused by COVID has been a stark reminder that the country needs hospice and palliative care expertise woven into all aspects of our healthcare system,” Baird said Hospice News in an email. “PCHETA would go a long way in helping achieve that goal by focusing on building and educating the next generation of leaders in this important space.”

If enacted, PCHETA would commit $100 million over five years to support programs aimed at expanding clinical education in hospice and palliative care and related interdisciplinary professions such as chaplaincy, pharmacy and social work support.

The legislation would establish grants through new palliative care and hospice education centers to provide short-term, intensive training and incentive programs in all relevant disciplines. In addition, it would support career development programs within the field.

The third time is a spell?

PCHETA was presented for the first time 2017 and again in 2019. The U.S. House of Representatives passed the bill both times, only to falter in the Senate — despite support from nearly 300 bipartisan fellow sponsors on the second attempt.

Sens. Tammy Baldwin (D-Wisc.) and Shelley Moore Capito (RW.Va.) revived PCHETA last week, and the bill has since added eight more co-sponsors.

The bill was also endorsed by more than 50 industry organizations. These include NAHC, as well as the National Hospice and Palliative Care Organization (NHPCO), the Hospice Action Network, the Hospice and Palliative Nurses Association, and the American Academy of Hospice and Palliative Medicine.

According to Logan Hoover, NHPCO director of legislative affairs, supporters are looking at every “nook and cranny” to move PCHETA forward.

“Legislation takes time and can sometimes be frustrating. But the intent is that when things move slowly, we make sure we get them right,” Hoover told Hospice News. “The language in PCHETA has been modified and perfected over time. Every time we bring it back, we get a step closer. I’m optimistic that we’ll get more support and strong momentum in the Senate this time around.”

The timing also makes a difference.

The latest attempt to advance the law coincided with the outbreak of the pandemic. While the bill has garnered bipartisan support, lawmakers’ attention needs to be focused on the COVID response, Hoover said.

A long, winding road through Congress

According to Baird, at today’s convention, PCCHETA will need additional co-sponsors from both sides of the aisle, along with support from influential advocacy groups representing patients, families, clinicians, payers and other key stakeholders.

“Proponents need to uphold the importance of PCHETA to keep it on the radar of congressional leadership,” he continued.

Even with that support, lawmakers may need to add their language to a separate, larger, and potentially “must-pass” piece of legislation later in the year, such as the B. a tax and health expansion package by the end of the year, Baird said.

“Congress produces fewer and fewer bills as time goes on, and it takes a bigger vehicle to move things like this forward,” Hoover said. “We have broad support, we just need the car to put it in. With the political wind we’re having right now, we’re going to have a handful of lame members just trying to get a few final victories together in a larger package, and that’s ultimately one of our best opportunities for something like PCHETA to fit in.”

It’s also important to remember that getting the bill passed and signed is not the end of its journey. Even if PCHETA is enacted, legislators would later have to allocate the funds for its implementation.

The current wording of the bill would authorize a maximum of $100 million, but that doesn’t guarantee the federal budget would include that total.

A drop in the bucket

PCHETA represents an important and historic investment in strengthening the workforce, but Baird said it will not be enough to fill all the gaps.

“We need a sustained and steady stream of funding to continue growing the pipeline of hospice and palliative care professionals,” Baird said. “Especially as the unprecedented workforce shortages and burnout crisis we now find ourselves in continue to impair organizations’ ability to serve those in need of quality and serious end-of-life care.”

This work pressure is a long-standing problem that has been made much worse by the pandemic.

According to a 2021 nationwide Morning Consult, around 18% of healthcare workers have left their jobs during the pandemic, while 31% have considered leaving the field opinion poll.

A large proportion of them, 79%, said widespread staff shortages played a role in their decisions, while burnout, poor wages and the pandemic itself were also key reasons.

NHPCO President and CEO Edo Banach stated in a statement that PCHETA would be a “down payment” for improvements and that a comprehensive plan is needed to address the ongoing bottlenecks.

“PCHETA and providing more education and more money will help address the problem going forward,” Banach said at the Hospice News Palliative Care Conference in Chicago. “But it takes a lot more than that.”

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