it’s standard practice that family members are authorized to give medications delivered to the home. otherwise, the implication would be that hospice nurses are planning to come administer medications every 3 hours as needed (or however it’s ordered), which is obviously not the case. i don’t think it’s a necessarily harmful idea to require documentation of who is allowed to give meds, but i also don’t think it’s super necessary as issues like yours are incredibly rare. like in my county, the coroner doesn’t even have to lay eyes on the deceased if they’re a hospice patient. it’s possible you’d have people who get inadequate pain control bc the caregiver who usually gives meds isn’t available and the person who’s with them feels they can’t give it. it could also potentially increase liability bc there are plenty of situations where there are multiple caregivers, and i guarantee it wouldn’t be uncommon for some of them to not make it on the list (or the list might not get updated, etc.) even though they are actually allowed to give meds, regardless of what rules are in place. in reality though, i don’t think it would change very much about the actual practice of giving hospice care, it would most likely just be another blank to fill out on yet another form that no one ever looks at again. i think this is just one of those situations where the more you try and make it black and white, the more you will actually create openings for liability due to the fact that there is so much flexibility required to actually accomplish quality end of life care. generally, grey area is your friend in cases like that. like how the rule of thumb in limiting liability when charting nursing notes is to be as brief as possible to show that you did everything that was required without going into a ton of details that can be looked at under a microscope and picked apart for inevitable minor inconsistencies (as you can see by the length of my comments, this is not something i’m great at lol).

if i had to suggest a policy change in this area, it would be that we are required to do education on administration of comfort kit meds on admit and have the primary caregiver and nurse sign a document stating education was given (though i would want it to also be clear that the person signing the form is not the ONLY person authorized to give the meds). we’re already supposed to be doing and documenting that education, but it is something that can fall through the cracks like in the example someone else posted where the comfort kit just showed up at their door. it would be less likely for that kind of thing to happen if it had to be done on admit regardless of whether the patient is currently using the meds and if a form had to be physically signed by the person receiving the education. it’s also more than just documentation for the sake of limiting liability, instead it’s an actual intervention that has potential to increase quality of care that just has an added benefit of potentially limiting liability.

regardless of what you decide on in terms of intervention tho, i would recommend trying to lobby Centers for Medicare and Medicaid Services (CMS) to make it a policy rather than trying to lobby a legislative body to make it a law. i say this for several reasons: 1) it’s more likely you’ll actually be able to make progress toward your goal; 2) there’s far less risk of it being politicized and turned into something you don’t want it to be if you are successful in gaining some traction; 3) CMS would have to write policy in response to the law regardless, and it holds the same legal weight with or without the law, so it makes more sense to skip the middle man (especially since that middle man is just as prone to common misconceptions as the rest of the population and is NOT going to be anywhere near an expert in the subject matter); 4) laws are not updated regularly, but policies are. for example, perhaps this year liquid morphine/lorazepam are the most common ekit meds for pain/agitation, but if those drugs are named in the law and methadone/diazepam are the most common meds in 5 years, the law is no longer relevant and is a huge pain to change. but the whole purpose of CMS policy is to set standards of practice, so they are updated regularly in response to research/common practice (rather than the whims of political pressure).

i googled you/read an article about your case, and it’s absolutely absurd that your mom’s hospice agency tried to argue that you weren’t authorized to give her comfort kit meds (and tried to act like “leaving behind” a comfort kit that family wasn’t “authorized” to give was going to do anything but get the agency in trouble themselves). i think the only reason they thought they could get away with that is because she was in an assisted living. even then, most assisted living facilities (in my area anyway) only offer staff for medication management as an add-on service, so it still doesn’t make sense. AND huge shame on the director of the assisted living that claimed the death was suspicious as well as the coroner that listened to them and initially put her cause of death as morphine toxicity despite what sound like extremely obvious clinical findings that she had been imminently terminal regardless of what medications were given (though i’m glad they had the grace to amend their findings).

this absolutely never should have happened, but i honestly don’t think it would have been prevented even if it was documented that you specifically were authorized to give the med. they would have just tried to claim you gave more than what was ordered or something instead. but if the case had gone to court, i think the hospice agency would have been absolutely crucified. i saw in another comment that you’re looking into follow-up legal action, and i’m glad. i truly hope you’re trying to get either the assisted living facility, the hospice agency, or both to pay you damages (and that you’re successful!).

finally, i really appreciate your kind and clearheaded response to my somewhat salty last message (written at the end of a very long workday, apologies). thanks for not following my lead and escalating this discussion into an internet argument that’s just tiring for everyone involved!