Palliative and End-of-Life Care: Policy Analysis
Purpose/Objectives: To present an overview of policy issues affecting hospice and palliative care focusing on the nursing home and hospital settings and to discuss factors affecting end-of-life care, policy initiatives, recent legislation, and nursing implications.
Data Sources: Published articles; technical, advisory, and research reports (from government, professional, and private organizations); newsletters; textbooks; meeting minutes; online references; and legislative documents.
Data Synthesis: Improvements are needed in end-of-life care, especially with regard to access, delivery, and financing of such services. Legal, organizational, and reimbursement policies, as well as healthcare professional education, have been identified as areas that need improvement. The nursing shortage and variable reimbursement policies for nursing services have a significant impact on access to quality end-of-life care, especially for underserved populations.
Conclusions: A need exists for further research, including demonstration projects to test new ways to deliver and integrate hospice and palliative care throughout the illness continuum. Education and research are needed regarding symptom management, communication and decision making, caregiver support, and other end-of-life issues. Nursing interventions, palliative care networks, and other models that promote a coordinated approach to care delivery have been shown to decrease costs and improve quality of care.
Implications for Nursing: Nurses play a key role in advancing improvements in palliative and end-of-life care through their involvement in educational, quality improvement, research, and legislative initiatives. Nursing activities in these areas may contribute to improved access, lower costs, and improved quality of care in advanced illness.
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References
Access to Cancer Therapies Act of 2001, H.R. 1624, 107th Cong. (2001).
Access to Cancer Therapies Act of 2001, S. 913, 107th Cong. (2001).
Advanced Planning and Compassionate Care Act of 1999, H.R. 1149, 106th Cong. (1999).
Advanced Planning and Compassionate Care Act of 2002, S. 2857, 107th Cong. (2002).
Alliance for Health Reform. (2001, December). "How do we pay for care at the end of life?" (Issue brief). Washington, DC: Author. Retrieved November 22, 2002, from http://www.alhealth.org/pub/pdf/12_01AHRv6.pdf
American Academy of Nurse Practitioners. (2001). Medicaid legislation needed [Legislative alert]. Retrieved April 9, 2002).from http://www.aanp.org
American Academy of Nursing's Palliative and End-of-Life Care Expert Panel. (2001). Palliative and End-of-Life Care Expert Panel meeting minutes. Washington, DC: Author.
American Academy of Pain Medicine. (2001). Centers for Medicare and Medicaid Services (CMS) establishes pain management code. Retrieved October 29, 2002, from http://www.painmed.org/news/pdf/specialty_code72.pdf
American Association of Colleges of Nursing. (2002a). End-of-life nursing consortium project. Retrieved October 29, 2002, from http://www.aacn.nche.edu/ELNEC/curriculum.htm
American Association of Colleges of Nursing. (2002b). Peaceful death: Recommended competencies and curricular guidelines for end-of-life nursing care. Retrieved October 29, 2002, from http://www.aacn.nche.edu/Publications/deathfin.htm
American Association of Colleges of Nursing. (2002c). Side-by-side comparison of the Nurse Reinvestment Act in the Senate and the House of Representatives. Retrieved October 29, 2002, from http://www.aacn.nche.edu/Government/sisebysidenra.htm
American Association of Critical Care Nurses. (1999). Designing an agenda for the nursing profession on end-of-life care. Retrieved October 29, 2002, from http://amsn.inurse.com/links/EOLRepor.pdf
American College of Nurse Practitioners. (2001). ACNP letter to CMS administrator Tom Scully in response to Federal Register proposed rule regarding Medicaid managed care. Retrieved March 22, 2002, from http://www.nurse.org/acnp/leg/scully.re.medicaid.shtml
American College of Nurse Practitioners. (2002a). Briefing paper: Geriatric Care Act. Retrieved November 25, 2002, from http://www.nurse.org/acnp/leg/geriatric,care,act.pdf
American College of Nurse Practitioners. (2002b). Briefing paper: Home health care certification. Retrieved November 25, 2002, from http://www.nurse.org/acnp/leg/home.care.cert.pdf
American College of Nurse Practitioners. (2002c). Briefing paper: Medicaid managed care. Retrieved October 29, 2002, from http://www.nurse.org/acnp/leg/medicaid.mgd.care.pdf
American Nurses Credentialing Center. (2002). Advanced practice palliative care nurse role delineation study [Internal report].
Americans for Better Care of the Dying. (2001). Federal policy updates: Patient bill of rights and conquering pain promise improved end-of-life care. Retrieved October 29, 2002, from http://www.abcd-caring.org/news/10706billofrights.htm
Americans for Better Care of the Dying. (2002). Summary of bills of the 107th Congress relating to end-of-life care. Retrieved November 5, 2002, from http://www.abcd-caring.org/news/107th_Congress_Bills.htm
Anderson, A. L., Gilliss, C. L., Yoder, L. (1996). Practice environment for nurse practitioners in California—Identifying barriers. Western Journal of Medicine, 165, 209-214.
Asch, D.A., Shea, J.A., Jedrziewski, M.K., & Bosk, C.L. (1997). The limits of suffering: Critical care nurses' views of hospital care at the end of life. Social Science Medicine, 45, 1661-1668.
Bernabei, R., Gambassi, G., Lapane, K., Landi, F., Gatsonis, C., Dunlop, R., et al. (1998). Management of pain in elderly patients with cancer. JAMA, 279, 1877-1882.
Bipartisan Patient Protection Act of 2001, H.R. 2563, 107th Cong. (2001).
Bipartisan Patient Protection Act of 2001, S. 1051, 107th Cong. (2001).
Bowen, M., Lyons, K.J., & Young, B.E. (2000). Nursing and health care reform: Implications for curriculum development. Journal of Nursing Education, 39, 27-33.
Bradley, E.H., Cherlin, E., McCorkle, R., Fried, T.R., Kasl, S.V., Cicchetti, D.V., et al. (2001). Nurses' use of palliative care practices in the acute care setting. Journal of Professional Nursing, 17, 14-22.
Buppert, C. (2002). Billing for nurse practitioner services: Guidelines for NPs, physicians, employers, and insurers. Retrieved October 29, 2002, from http://www.medscape.com/viewarticle/422935
Byock, I. (1998). Hospice and palliative care: A parting of ways or a path to the future? Journal of Palliative Medicine, 1, 165-176.
Capello, C.F., Meier, D.E., & Cassel, C.K. (1998). Payment code for hospital-based palliative care: Help or hindrance? Journal ofPalliative Medicine, 1, 155-160.
Cassel, C.K., Ludden, J.M., & Moon, G.M. (2000). Perceptions of barriers to high quality palliative care in hospitals. Health Affairs, 19, 166-172.
Cohen, S.S., & Juszczak, L. (1997). Promoting the nurse practitioner role in managed care. Journal of Pediatric Health Care, 11, 3-11.
Conquering Pain Act of 1999, H.R. 2188, 106th Cong. (1999).
Conquering Pain Act of 1999, S. 941, 106th Cong. (1999).
Conquering Pain Act of 2001, H.R. 2156, 107th Cong. (2001).
Conquering Pain Act of 2001, S. 1024, 107th Cong. (2001).
Consolidated Appropriations Act of 2001, Pub. L. No. 106-554, § § 121, 321, 114 Stat. 2763, 2763A-474-2763A-476, 2763A-500-2763A-501.
Dahlin, C., Campbell, M., & McCorkle, R. (2002). Advanced practice nurses' role in palliative care: A position statement from American nursing leaders. Retrieved November 22, 2002, from http://www.promotingexcellence.org/apn
Derby, S., & Sherman, D.W. (2000). The first ever palliative care NP program in the U.S. Nursing Spectrum. Retrieved February 26, 2002, from http://community.nursingspectrum.com/MagazineArticles/article.cfm?AID=1282
Disease management and care coordination: What role can they play in improving the quality of life for Medicare's most vulnerable? Hearing before the Senate Special Committee on Aging, 107th Cong. (2002).
Emmer, S. (2001). New administration, new directions for end-of-life care? Retrieved March 6, 2001, from http://www.abcd-caring.org/legislativeupdate.htm
Emnett, J., Byock, I., & Twohig, J.S. (2002). Advanced practice nursing: Pioneering practices in palliative care [Monograph]. Retrieved November 22, 2002, from http://www.promotingexcellence.org/apn
The end of life: Improving care and helping families: Hearing before the Senate Special Committee on Aging, 106th Cong. (2000).
Ferrell, B.R., Borneman, T., & Juarez, G. (1998). Integration of pain education in home care. Journal of Palliative Care, 14, 62-68.
Ferrell, B.R., & Grant, M. (2001). [Letter to the editor]. Journal of Professional Nursing, 17, 107-108.
Ferrell, B.R., Grant, M., & Virani, R. (1999). Strengthening nursing education to improve end-of-life care. Nursing Outlook, 47, 252-256.
Ferrell, B.R., Virani, R., & Grant, M. (1998). HOPE: Home care outreach for palliative care education. Cancer Practice, 6, 79-85.
Field, M.J., & Berhman, R.E. (Eds.). (2002). When children die: Improving palliative and end-of-life care for children and their families. Washington, DC: National Academy Press.
Field, M.J., & Cassel, C.K. (Eds.). (1997). Approaching death: Improving care at the end of life. Washington, DC: National Academy Press.
Foley, K.M., & Gelband, H. (Eds.). (2001). Improving palliative care for cancer. Washington, DC: National Academy Press.
Fox, E., Landrum-McNiff, K., Zhong, Z., Dawson, N., Wu, A., & Lynn, J. (1999). Evaluation of prognostic criteria for determining hospice eligibility in patients with advanced lung, heart, or liver disease. JAMA, 282, 1638-1645.
Geriatric Care Act of 2001, H.R. 3027, 107th Cong. (2001).
Geriatric Care Act of 2001, S. 775, 107th Cong. (2001).
Glajchen, M., & Bookbinder, M. (2001). Knowledge and perceived competence of home care nurses in pain management: A national survey. Journal of Pain and Symptom Management, 21, 307-316.
Glanville, I., Schirm, V., & Wineman, N.M. (2000). Using evidence-based practice for managing clinical outcomes in advanced practice nursing. Journal of Nursing Care Quality, 15(1), 1-11.
Grady, P.A. (2002a). News from NINR: Congressional testimony 2002: Nurse scientists face the challenge. Nursing Outlook, 50(3), 89.
Grady, P. A. (2002b). News from NINR: Moving the science forward together. Nursing Outlook, 50(4), 136.
Grant, M., Ferrell, B.R., Rivera, L.M., & Lee, J. (1995). Unscheduled read-missions for uncontrolled symptoms. Nursing Clinics of North America, 30, 673-682.
Halpern, I. (2002, February). ONS legislative agenda, advocacy 101, and Capitol Hill updates. Paper presented at the meeting of the Washington, D.C., chapter of the Oncology Nursing Society, Washington, DC.
Halpern, I.M., & Waters, B. (2002a, August). ONS Hill Day—Results are farreaching and tangible. ONS News, 17(8), 6.
Halpern, I.M., & Waters, B. (2002b, May). Policy institute and Nurse in Washington Internship program teach nurses the finer points of advocacy. ONS News, 17(5), 12.
Haylock, P.J. (2000). Health policy and legislation: Impact on cancer nursing and care. Seminars in Oncology Nursing, 16, 76-84.
Healthcare Research and Quality Act of 1999, 42 U.S.C. § 299 (2000).
Henderson, M.L. (2000). Action plan for addressing palliative care/end-of-life issues by ACNP. Retrieved October 29, 2002, from http://www.nurse.org/acnp/endoflife/eol.action.plan.shtml
Hodges, H.F. (1997). Seeking balance to dialectic tensions in teaching through philosophic inquiry. Image: Journal of Nursing Scholarship, 20, 349-354.
Hoffmann, D.E. (1998). Pain management and palliative care in the era of managed care: Issues for health insurers. Journal of Law, Medicine, and Ethics, 26, 267-289.
Home Health Nurse and Patient Act of 2001, S. 1169, 107th Cong. (2001).
Hospice and Palliative Care Nurses Association. (2002). National board certification of hospice and palliative nurses. Retrieved November 17, 2002, from http://www.hpna.org/nbchpn/index.htm
Hospice Improvement Program Act of 2001, H.R. 3492, 107th Cong. (2001).
Hospice Improvement Program Act of 2001, S. 1425, 107th Cong. (2001).
Huskamp, H.A., Buntin, M.B., Wang, V., & Newhouse, J.P. (2001). Providing care at the end of life: Do Medicare rules impede good care? Health Affairs, 20, 204-211.
Improving care at the end-of-life with complementary medicine: Hearing before the Government Reform Committee, 106th Cong. (1999) (testimony of Patricia Grady).
Ingham, J.M. (2000). End-of-life considerations in breast cancer patients. In J.R. Harris, M.E. Lippman, M. Morrow, & C.K. Osborne, (Eds.) Diseases of the breast (2nd ed., pp. 967-983). Philadelphia: Lippincott Williams and Wilkins.
Kane, R.L., & Huck, S. (2000). The implementation of the EverCare demonstration project. Journal of the American Geriatric Society, 48, 218-223.
Last Acts. (2000). Michigan partnership received $450,000 grant to improve end-of-life care. Retrieved October 29, 2002, from http://www.lastacts.org/scripts/la_mrc.exe?FNC=get_archived_nr_detail_Ala_mrc_news_archive_list_html_1881
Last Acts. (2001). 106th Congress legislative wrap-up and look ahead. Retrieved December 9, 2002, from http://www.lastacts.org/statsite/33591a%5Fmrc%5Fnewsrelease.html
Last Acts. (2002). Means to a better end: A report on dying in America today. Retrieved November 22, 2002, from http://www.lastacts.org/files/misc/meansfull.pdf
Leight, S.B. (2002). Starry night: Using story to inform aesthetic knowing in women's health nursing. Journal of Advanced Nursing, 37, 108-114.
Lindeke, L.L., & Chesney, M.L. (1999). Reimbursement realities of advanced nursing practice. Nursing Outlook, 47, 248-251.
Living Well With Fatal Chronic Illness Act of 2002, H.R. 5139, 107th Cong. (2002).
Lynn, J. (2002a, March). Improving end of life care. Paper presented at the Lombardi Palliative Care Ground Rounds: Meet the Experts in Palliative Care, Washington, DC.
Lynn, J. (2002b, September). Where we are: End of life in research, finance, and legislation. Paper presented at the Georgetown University School of Nursing and Health Studies meeting: Meeting People Where They Are: Palliative Care Across Healthcare Settings, Washington, DC.
Lynn, J., Wilkinson, A., & Etheredge, L. (2001a). Financing care for fatal chronic disease: Opportunities for Medicare reform [Electronic version]. Western Journal of Medicine, 175, 299-302. Retrieved November 27, 2002, from http://www.ewjm.com/cgi/reprint/175/5/299.pdf
Lynn, J., Wilkinson, A., & Etheredge, L. (2001b). Financing care for those coming to the end of life. In L. Snyder & T.E. Quill, (Eds.) Physician's guide to end-of-life care (pp. 214-233). Philadelphia: American College of Physicians.
McCall, N., Komisar, H.L., Petersons, A., & Moore, S. (2001). Medicare home health before and after the BBA. Health Affairs, 20, 189-198.
Medicaid Nursing Incentive Act of 2001, H.R. 3594, 107th Cong. (2001).
Medicare Chronic Care Improvement Act of 2001, H.R. 3188, 107th Cong. (2001).
Medicare Chronic Care Improvement Act of 2001, S. 1589, 107th Cong. (2001).
Medicare Payment Advisory Commission. (1998). Report to the Congress: Context for a changing Medicare program. Washington, DC: Author.
Medicare Payment Advisory Commission. (1999). Report to the Congress: Selected Medicare issues. Washington, DC: Author.
Medicare Payment Advisory Commission. (2002a). Report to the Congress: Assessing Medicare benefits. Washington, DC: Author.
Medicare Payment Advisory Commission. (2002b). Report to the Congress: Medicare beneficiaries' access to hospice. Washington, DC: Author.
Medicare payments for currently covered prescription drugs: Hearing before the House Ways and Means Health Subcommittee, 107th Cong. (2002). (written testimony of Judy Lundgren and Pearl Moore).
Meier, D.E., Morrison, R.S., & Cassel, C.K. (1997). Improving palliative care. Annals of Internal Medicine, 127, 225-230.
Meleis, A.I. (1997). Theoretical nursing: Development and progress (3rd ed.). Philadelphia: Lippincott-Raven.
Metzger, M., & Kaplan, K.O. (2001). Transforming death in America: A state of the nation report. Washington, DC: Last Acts.
Miaskowski, C. (2001). Monitoring and improving pain management practices: A quality improvement approach. Critical Care Nursing Clinics of North America, 13, 311-317.
Milder, B., & Crowell, B. (2001a, October). HHS awards grants for family caregivers. Last Acts Policy Newsletter, 2(10), 2.
Milder, B., & Crowell, B. (2001b, September). HHS awards Native American and Hawaiian caregiver grants. Last Acts Policy Newsletter, 2(9), 3-4.
Milder, B., & Crowell, B. (2001c, November). HHS to expand available health care quality data. Last Acts Policy Newsletter, 2(11), 2.
Milder, B., & Crowell, B. (2001d, October). Michigan House adopts end-of-life care resolutions. Last Acts Policy Newsletter, 2(10), 1-4.
Milder, B., & Crowell, B. (2001e, September). Senate Aging Committee holds third hearing on long-term care. Last Acts Policy Newsletter, 2(9), 1-2.
Milder, B., & Crowell, B. (2002a, August/September). Aging Committee holds hearing on disease management. Last Acts Policy Newsletter, 3(9), 4.
Milder, B., & Crowell, B. (2002b, May). Aging Subcommittee holds hearing on family caregivers. Last Acts Policy Newsletter, 3(5), 1.
Milder, B., & Crowell, B. (2002c, April). House Ways and Means Committee looks at disease managment. Last Acts Policy Newsletter, 3(4), 2-3.
Milder, B., & Crowell, B. (2002d, January). New CMS pain management code takes effect. Last Acts Policy Newsletter, 3(1), 3.
Milder, B., & Crowell, B. (2002e, March). Senate Aging Committee holds hearings on long-term care. Last Acts Policy Newsletter, 3(3), 3-4.
Milder, B., & Crowell, B. (2002f, August/September). Senator Baucus sponsors Capitol Hill briefing on end-of-life care. Last Acts Policy Newsletter, 3(9), 2.
Milder, B., & Crowell, B. (2002g, June). Special Committee on Aging releases report on long-term care. Last Acts Policy Newsletter, 3(6), 2-3.
Mooney, K.H. (2000). Oncology nursing education: Peril and opportunities in the new century. Seminars in Oncology Nursing, 16, 25-34.
Mooney, K.H. (2001). Advocating for quality cancer care: Making evidence-based practice a reality. Oncology Nursing Forum, 28(Suppl. 2), 17-21.
Murphy, P.A., Price, D.M., Stevens, M., Lynn, J., & Kathryn, E. (2001). Under the radar: Contributions of the SUPPORT nurses. Nursing Outlook, 49, 238-242.
National Association for Home Care. (2002a). Medicare reform legislation bill eliminates a scheduled 15% cut for home health without imposing injurious home health copays. Retrieved November 22, 2002, from http://www.nahc.org/NAHC/NewsInfo/02nr/MedReformLeg.html
National Association for Home Care. (2002b). NAHC president expresses "profound dismay" that HHS advocates further cuts in the Medicare home health benefit. Retrieved November 22, 2002, from http://www.nahc.org/NAHC/NewsInfo/02nr/OMB-HHSreaction.html
National Hospice and Palliative Care Organization. (2002). Hospice included in Nurse Reinvestment Act. Retrieved November 22, 2002, from http://www.nhpco.org/public/articles/details.cfm?id=950
National Institute of Nursing Research. (1997). Summary of the Capitol Hill breakfast briefing on pain management. Retrieved October 29, 2002, from http://www.nih.gov/ninr/about/legislation/caphillpain.htm
National Institute of Nursing Research. (1998). Summary of the Capitol Hill breakfast briefing on end-of-life care. Retrieved October 29, 2002, from http://www.nih.gov/ninr/about/legislation/eolbriefing.htm
National Institute of Nursing Research. (1999). Summary of the Capitol Hill breakfast briefing on quality of life for patients with chronic illness. Retrieved October 29, 2002, from http://www.nih.gov/ninr/about/legislation/chronic_illness.htm
National Institute of Nursing Research. (2000). The end of our lives: Guiding the research agenda. Bethesda, MD: Author.
National Institute of Nursing Research. (2001a). End of life. Retrieved October 29, 2002, from http://www.nih.gov/ninr/news-info/pubs/outlookjan01.htm
National Institute of Nursing Research. (2001b). Minutes of the National Advisory Council for Nursing Research. Retrieved March 18, 2002, from http://www.nih.gov/ninr/about/adv-council/meetings/minutes101.pdf
National Institute of Nursing Research. (2001c). Nursing shortage. Retrieved October 29, 2002, from http://www.nih.gov/ninr/news-info/pubs/outlookmay01.html
National Institute of Nursing Research. (2001d). Research in informal caregiving: State of the science workgroup meeting. Retrieved October 29, 2002, from http://www.nih.gov/ninr/research/dea/workgroup_chronic_conditions.html
National Institutes of Health. (1997). Symptoms in terminal illness: A research workshop. Retrieved October 29, 2002, from http://www.nih.gov/ninr/wnew/symptoms_in_terminal_illness.html
National Institutes of Health. (2002). Symptom management in cancer: Pain, depression, and fatigue. State-of-the-science conference statement. Retrieved November 8, 2002, from http://consensus.nih.gov/ta/022/022_intro.htm
Nurse Reinvestment Act of 2002, 42 U.S.C. § 297 et seq. (2002).
Older Americans Act Amendments of 2000, 42 U.S.C. § 3030s (2000).
Oncology Nursing Society. (2002a). General principles and policies regarding Medicare reimbursement (Issue brief). Retrieved November 27, 2002, from http://www.ons.org/images/library/ons_publications/PDFs/Legislative/Principles.pdf
Oncology Nursing Society. (2002b). Nursing shortage (Issue brief). Retrieved October 29, 2002, from http://www.ons.org/images/Library/ons_publications/PDFs/Legislative/ShortageBrief.pdf
Oncology Nursing Society. (2002c). ONS 107th Congress, 1st Session legislative wrap-up and outlook. Retrieved February 20, 2002, from http://www.ons.org/xp6/ONS/News.xml/Briefs.xml
Oncology Nursing Society. (2002d). Reimbursement vs. reality: A discussion paper on Medicare payments for cancer treatments (Issue brief). Retrieved November 27, 2002, from http://www.ons.org/images/Library/ons_publications/PDFs/Legislative/Reimbursement.pdf
Pain Relief Promotion Act of 1999, H.R. 2260, 106th Cong. (1999).
Pain Relief Promotion Act of 1999, S. 1272, 106th Cong. (1999).
Petrisek, A.C., & Mor, V. (1999). Hospice in nursing homes: A facility-level analysis of the distribution of hospice beneficiaries. Gerontologist, 39, 279-290.
Project on Death in America. (2000). Nursing professionals unite to improve end-of-life care for patients and families. Retrieved October 29, 2002, from http://www.soros.org/death/prOct3_00.htm
Promoting Excellence in End-of-Life Care. (2002). Webcast of financial implications of promoting excellence in end-of-life care [Press release]. Retrieved November 8, 2002, from http://www.promotingexcellence.org/content/091002pr.html
Quality of Care for Individuals With Cancer Act of 2002, S. 2965, 107th Cong. (2002).
Raphael, C., Ahrens, J., & Fowler, N. (2001). Financing end-of-life care in the USA. Journal of the Royal Society of Medicine, 94, 458-461.
Rudberg, M.A., Teno, J.M., & Lynn, J. (1997). Developing and implementing measures of quality of care at the end-of-life: A call for action. Journal of the American Geriatric Society, 45, 528-530.
Rushton, C.H., & Sabatier, K.H. (2001). The nursing leadership consortium on end-of-life care: The response of the nursing profession to the need for improvement in palliative care. Nursing Outlook, 49, 58-60.
Rushton, C.H., Sabatier, K.H., & Spencer, K.L. (2002). Advancing the Nursing Leadership Academy agenda for improving palliative and end-of-life care. Nursing Outlook, 50, 214.
Ryndes, T., Connor, S., Cody, C., Merriman, M., Bruno, S., Fine, P., et al. (2000). Report on the alpha and beta pilots of end result outcome measures constructed by the outcomes forum. Retrieved November 22, 2002, from http://www.nhpco.org/public/articles/OCFFINALRPT.pdf
Sabatino, C.P. (1998). Legislative trends in end-of-life care: State-by-state overview shows much activity. Retrieved September 8, 2001, from http://www.abanet.org/aging/update.html
Sabatino, C.P. (2000a). End-of-life care legal trends [Internal memorandum]. Retrieved September 8, 2001, from http://www.abanet.org/elderly/update.html
Sabatino, C.P. (2000b). End-of-life care legislation summary. Retrieved September 8, 2001, from http://www.abanet.org/elderly/update.html
Sabatino, C.P. (2001). End-of-life care legislation summary. Retrieved February 28, 2002, from http://www.abanet.org/elderly/update.html
Senate Special Committee on Aging. (2002). Aging Committee: Hearing finding summary. Washington, DC: U.S. Government Printing Office.
Smith, T. (2000, November). Technological interventions in end-of-life care. Paper presented at the National Institutes of Health End-of-Life Research Group symposium, The End of Our Lives: Guiding the Research Agenda, Bethesda, MD.
Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatment Principle Investigators. (1995). A controlled trial to improve care for seriously ill hospitalized patients. JAMA, 274, 1591-1598.
Teno, J.M. (2001). Quality of care and quality indicators for end-of-life cancer care: Hope for the best, yet prepare for the worst. In K. Foley & H. Gelband, (Eds.) Improving palliative care for cancer (pp. 96-131). Washington, DC: National Academy Press.
Tilly, J., & Wiener, J. (2001). Medicaid and end-of-life care. Vienna, VA: Last Acts.
Turk, L., Parmley, J., Ames, A., & Schumacher, K. (2000). A new era in home care. Seminars for Nurse Managers, 8, 143-150.
U.S. General Accounting Office. (1998). Suicide prevention: Efforts to increase research and education in palliative care. Washington, DC: Author.
Walsh, D. (1998). The Medicare hospice benefit: A critique from palliative medicine. Journal of Palliative Medicine, 1, 147-149.
Walsh, D., & Gordon, S. (2001). The terminally ill: Dying for palliative medicine? American Journal of Hospice and Palliative Care, 18, 203-205.
World Health Organization. (1990). WHO definition of palliative care. Retrieved October 29, 2002, from http://www.who.int/dsa/justpub/cpl.htm
Zerzan, J., Stearns, S., & Hanson, L. (2000). Access to palliative care and hospice in nursing homes. JAMA, 284, 2489-2494.