Hawaii-2019-HB1447-Amended

SECTION 1. The legislature finds that numerous studies show that palliative care significantly improves patient quality of life and lowers symptom burden. Palliative care is defined by the World Health Organization 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, assessment, and treatment of pain and other issues of a physical, psychosocial, and spiritual nature. Palliative care has a team approach that utilizes a team of clinicians, physician, nurse, social worker, and chaplain, who work with the persons with serious illness and their loved ones. It is an extra layer of support that can be offered at the same time as curative treatments, and may continue after curative treatments are completed. However, there is often misunderstanding about palliative care, which is often confused with hospice and end-of-life care. While hospice is a type of palliative care, it is provided when there is a six-month or less diagnosis and once curative treatments have stopped. All palliative care strives to provide is the best quality of life for those with serious illness and their loved ones.

The legislature further finds that palliative care and hospice utilization in Hawaii deviates from mainland patterns. A 2017 study conducted by Deborah A. Taira et al., Hospice Utilization of Medicare Beneficiaries in Hawaii Compared to Other States, found that hospice utilization was 45.7 per cent compared to a national average of 52 per cent; the mean length of stay was sixty days compared with seventy-one days nationally. A consistent finding of this study is that Asian and Pacific Islanders (API) were less likely to enroll in hospice and that "[f]urther research is needed to understand these differences and eliminate potential barriers to hospice care." A key concept identified by this analysis is that Hawaii's culture, uniquely influenced by Asian values compared to the mainland, emphasizes filial piety and "the expectation of caring for their loved ones at home rather than in a nursing home."

Other studies make similar observations, such as Merle R. Kataoka-Yahiro et al., Culturally Competent Palliative and Hospice Care Training for Ethnically Diverse Staff in Long-Term Care Facilities, which found that culturally competent palliative and hospice training is a promising practice to increase patient, family, and provider engagement with end-of-life conversations.

Therefore, the purpose of this Act is to support activities that increase the utilization of palliative care in Hawaii by requiring the department of health to establish a culturally competent palliative care pilot program to promote public education and the development of practices specific to the State's unique cultural norms.

SECTION 2. (a) The department of health shall establish a culturally competent palliative care pilot program. The pilot program shall:

(1) Provide public education to:

(A) Promote palliative care utilization;

(B) Emphasize referrals to palliative care earlier during treatment for patients; and

(C) Acquire local health care utilization data for purposes of more precisely measuring palliative care utilization in the State; and

(2) Conduct competitive bidding for at least two home- or community-based palliative care projects; provided that at least one shall be implemented in a county with a population of less than 200,000.

(b) In administering the pilot program, the department of health shall collaborate with:

(1) The mayors of the counties in which the projects are implemented, or their respective designees;

(2) The chief executive of a hospital in the region in which the projects are implemented;

(3) A representative from the John A. Burns School of Medicine;

(4) A representative from the American Cancer Society;

(5) A representative from Kokua Mau;

(6) A patient, or family member of a patient, who previously received palliative care; and

(7) A registered nurse or advanced practice registered nurse.

(1) A preliminary report on the progress and expenditure of funds for the culturally competent palliative care pilot program no later than twenty days prior to the convening of the regular session of 2020; and

(2) A final report on the pilot program, its findings and recommendations, including any proposed legislation and report on the expenditure of all funds for the culturally competent palliative care pilot program, no later than twenty days prior to the convening of the regular session of 2022.

SECTION 3. There is appropriated out of the general revenues of the State of Hawaii the sum of $ or so much thereof as may be necessary for fiscal year 2019-2020 and the same sum or so much thereof as may be necessary for fiscal year 2020-2021 for the culturally competent palliative care pilot program.

The sums appropriated shall be expended by the department of health for the purposes of this Act.

SECTION 4. This Act shall take effect on July 1, 2050.

HOUSE OF REPRESENTATIVES	H.B. NO.	1447
THIRTIETH LEGISLATURE, 2019		H.D. 1
STATE OF HAWAII