Hospice service - Extraordinary Circumstance” Exemption

Qualifying for an “Extraordinary Circumstance” Exemption

Between October 1, 2002, and September 30, 2004, in order to qualify for an “extraordinary circumstance” exemption, a hospice must notify the state agency responsible for licensing and certification that it intends to elect an exception under the “extraordinary circumstance” authority. This may be accomplished by providing written notification to the state survey agency when it believes that the nursing shortage has become an “extraordinary circumstance” in its ability to hire nurses directly, and it must estimate the number of nurses that it believes it will currently need to employ under contract. Notification may be made during the period from October 1, 2002, through September 30, 2004, and should address the following:


a. An estimate of the number of patients that it has not been able to admit during the past three months due to the nursing shortage and provide the current and desired patient/nurse ratio for the agency;

b. Evidence that the hospice has made a good faith effort to hire and retain nurses, including:
Copies of advertisements in local newspapers that demonstrate recruitment efforts;
Copies of reports of telephone contacts with potential hires, professional schools and organizations, recruiting services, etc.;

Job descriptions for nurse employees;

Evidence that salary and benefits are competitive for the area;

Evidence of any other recruiting activities (e.g., recruiting efforts at health fairs, educational institutions, health care facilities, and contacts with nurses at other providers in the area); and

Ongoing self-analysis of the hospice’s trends in hiring and retaining qualified staff.

c. The hospice must also demonstrate that it has a training program in place to assure that contracted staff is trained in the hospice philosophy and the provision of palliative care prior to patient contact.


d. The hospice must assure that contracted staff is providing care that is consistent with the hospice philosophy and the patient’s plan of care.

e. Contracted nurses are used to supplement the hospice nurses employed directly. Contracted nurses should not be used solely to provide the continuous nursing level of care or on call service.

f. The hospice is expected to continue its recruitment efforts during the period that it is contracting for nurses.