Palliative care is medical care with goal of relieving the stress, pain and symptoms of serious and terminal illnesses. Its aim is not curative, and while palliative care has been practiced since the 4th century, its presence within the United States has only gained considerable ground in the last few decades. Recently, the state of New York passed two laws aiming to ensure all terminally ill patients who receive health care within the state are given adequate information, counseling and access to palliative care and other end-of-life options. Named the Palliative Care Information Act (PCIA) and the Palliative Care Access Act (PCAA), these two legislative efforts are trying to change how dying and significant illness are experienced in the Empire State.
If you’re embarking on a career in nursing or medicine in New York, the PCIA and PCAA are almost guaranteed to play a role in the care you provide. The state wants to reduce the suffering of terminally ill people and their loved ones, and has passed these two laws to help. Here are a handful of ways PCIA and PCAA are trying to change end-of-life and serious-illness care across the state of New York.
PCIA and PCAA — Similarities and Differences
In many ways, the Palliative Care Information Act and the Palliative Care Access Act are two sides of the same coin. Basically, the PCAA applies to the agencies of care: hospitals, clinics, home-care organizations, nursing homes, rehab facilities and the like, whereas the PCIA applies to the doctors and nurses who provide care within those facilities. Both laws apply to patients and residents whose illness would be benefited by palliative care treatment — regardless of whether it is terminal or not. Taken together, both laws ensure information and access regarding palliative care is provided to the patient.
Requirements of the Attending Healthcare Practitioner
New York’s Palliative Care Information Act requires every attending health care practitioner — including doctors and nurse practitioners — to offer terminally-ill or seriously-ill patients counseling services regarding their end-of-life options. The law emphasizes and encourages discussions between healthcare providers and their patients regarding the goals and limits of such care, as well as how pain and symptoms can be best managed. Before the law was in effect, patients or their families often had to shoulder the responsibility of discovering and inquiring about palliative services; now responsibility is on the shoulders of the attending care provider.
How Information Is Disseminated
The attending health care provider can give her patients information and counseling regarding palliative care either in writing or through conversation. The one caveat is how the information is disseminated must be “appropriate to the patient.” According to the legal definition in this context, “appropriate” means:
- The information given is consistent with professional standards.
- The information given must be consistent with the patient’s condition.
- The information given should be consistent with what is known about the patient’s beliefs and desires.
Requirements for Care Facilities
Care facilities in New York are required to provide access to information and counseling services for any of their patients who have a terminal illness or “advanced life-limiting condition.” In addition to information, facilities must also assist with access to information and counseling. If a patient whose needs are affected by the laws is unable to make health care decisions due to illness, the patient’s care facility must have policies and procedures in place to identify who is legally authorized to make health care decisions for the patient. They must then provide information and counseling to that person. In addition, all care facilities must facilitate and provide access to patients who need palliative care services.
Documentation and Compliance
Hospitals and other care facilities are required to document when and how they complied with PCIA and PCCA. They do so by recording the following information in the patient’ medical record:
- When the offer of palliative care was made
- Who made the offer
- The patient’s response
- Notes regarding the discussion, such as options chosen and questions asked
- How the palliative care will be provided
Failure to comply with either law can result in civil penalties ranging from $2,000 to $10,000 depending on the severity of the offense.
Life-limiting illness and impending death are difficult realities for anyone to handle. In New York, the recent legislative emphasis on relieving the suffering for people nearing the end of their lives is trying to mitigate those difficulties as much as possible.