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<regulation prefix="Regulation" num=".08" citation="COMAR 10.07.21.08" title_num="10" subtitle_num="07" chapter_num="21" heading="Personnel.">
  <paragraph num="A.">
    <text>The hospice care program shall maintain sufficient health care professionals and volunteers to meet patient care needs.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The hospice care program shall identify an interdisciplinary care team with responsibility for ensuring continuous assessment of the patient's and family's needs and implementation of an integrated plan of care. The hospice care program shall ensure that:</text>
    <paragraph num="(1)">
      <text>A qualified health care professional coordinates the activities of the interdisciplinary care team;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The number of individuals who perform interdisciplinary team services is consistent with the needs of patients and their families and the type of services provided by the hospice care program; and</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Each interdisciplinary care team consists of at least:</text>
      <paragraph num="(a)">
        <text>The patient's attending physician;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A physician with training in palliative care;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>A registered nurse with demonstrated experience in pain and symptom management and the performance of physical assessments;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>A master's degree-prepared social worker with clinical experience in counseling and casework for the terminally ill;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>A volunteer, or volunteers, supervised by an individual with management experience in a hospice care program; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>A spiritual care counselor or counselors with education and experience in pastoral counseling.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>An interdisciplinary care team may include additional specialized team members needed to meet specific needs of patients as outlined in the patient's plan of care. Specialized team members may include allied therapists, art and music therapists, registered dietitians or licensed nutritionists, pharmacists, or nursing assistants.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Specialized team members may be employees, volunteers, or contractual staff.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Personnel Records. For all employees, volunteers, and contractual staff, the administrator shall ensure that there is:</text>
    <paragraph num="(1)">
      <text>An accurate, complete, and current personnel record that includes:</text>
      <paragraph num="(a)">
        <text>Verification of required licenses or certification;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>A signed conflict of interest statement;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Written performance reviews;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Documentation of all required training; and</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A job description for each position.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>Outside Agreements. If a hospice care program utilizes the services of an outside entity to provide certain hospice services, the hospice care program shall enter into a written agreement with that entity which includes at a minimum:</text>
    <paragraph num="(1)">
      <text>The service or services to be provided;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The roles, rights, and responsibilities of the contracting entity;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The roles, rights, and responsibilities of the hospice care program; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A plan to ensure that any individual providing services under this section shall have at least comparable training to that required by this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>Orientation and Training.</text>
    <paragraph num="(1)">
      <text>The hospice care program shall ensure that all licensed staff receive orientation and training, which includes at a minimum:</text>
      <paragraph num="(a)">
        <text>The purpose and philosophy of hospice care;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The skills necessary to provide for the physical care of the patient;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The skills necessary to provide for the psychosocial and spiritual needs of the patient and family; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The need and importance of maintaining professional boundaries with the patient and the patient's family.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The hospice care program shall have written criteria and a clear process for recruiting, selecting, and supervising volunteers, ensuring that:</text>
      <paragraph num="(a)">
        <text>Any volunteer who provides direct patient care receives appropriate orientation and at least 16 hours of training which includes, at a minimum:</text>
        <paragraph num="(i)">
          <text>The purpose and philosophy of hospice care;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>The role of the volunteer in hospice;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Concepts of death and dying;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Communication skills;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Care and comfort measures;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>The physical, psychosocial, and spiritual issues related to death and dying;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>The concept of the hospice family;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Patient rights;</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Confidentiality;</text>
        </paragraph>
        <paragraph num="(x)">
          <text>Bereavement;</text>
        </paragraph>
        <paragraph num="(xi)">
          <text>Infection control;</text>
        </paragraph>
        <paragraph num="(xii)">
          <text>Safety; and</text>
        </paragraph>
        <paragraph num="(xiii)">
          <text>Stress management; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>A volunteer, other than those specified in §G(2)(a) of this regulation, receives appropriate orientation regarding the volunteer's role in the hospice care program.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Training shall be specifically tailored to ensure that staff is capable of providing care to meet the individual needs of patients.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The hospice care program shall provide continuing inservice education for all employees and volunteers providing direct patient services at least:</text>
      <paragraph num="(a)">
        <text>Once a year for volunteers; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Four times a year for employees.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>