State parliament considers bill allowing nursing staff to issue dying declarations

The Pennsylvania State Senate has approved a bill that would expand the staffing requirements for death declarations to include a wider range of hospice physicians.

If enacted, the bill would allow nurses providing hospice care to make death declarations. Currently, only nurses, physicians, physician assistants and coroners are authorized to make death declarations in the state under the Vital Statistics Act of 1953.

The bill was recently introduced by Republican Senator Lynda Schlegel Culver and is currently being considered by the state House Health Committee. The bill comes at a time when health care costs are rising and work pressures are increasing, according to Culver.

“It can be costly to require a physician, nurse, physician assistant or medical examiner to provide a death declaration when that function could easily be performed by a nurse practitioner,” Culver said in a statement. “Nurses provide care up until the time of death, but when the patient dies, the nurse practitioner no longer has the authority to provide a death declaration.”

The legislation was introduced against the backdrop of severe staffing shortages facing hospice providers, Culver said. Giving nurses the authority to make death declarations could help hospices better allocate their resources, Culver explained.

Similar to national trends, in Pennsylvania the demand for hospice exceeds the number of interdisciplinary professionals to provide this care.

According to the U.S. Centers for Medicare & Medicaid Services (CMS), approximately 73,963 Medicare decedents used hospice in Pennsylvania in 2021, which is in the middle of the range among states. Hospice use was highest in California and Florida this year, with 156,000 and 154,521 decedents, respectively.

The number of hospice providers in Pennsylvania fell 4.7% between 2017 and 2019, with the decline being more pronounced in rural communities than in urban areas, according to a report from the Center for Rural Pennsylvania. Many of the state’s rural regions have only one hospice organization serving multiple counties, and they often struggle with staff shortages, rising demand and higher travel costs, the report said.

According to the U.S. Census Bureau, seniors age 65 and older make up 20% of Pennsylvania’s total population.

This aging population will spend the end of their lives in a variety of community- and facility-based settings where hospice care is available, Culver said. Having caregivers available to assist with death notifications could help improve the quality of care for families, Culver said.

“LPNs provide high-quality, essential care during a very emotional time for patients and their families,” Culver said. “LPNs in hospices provide end-of-life care for patients in the weeks and months before their death.”