SB1080/Act137: Pronouncement of Death by a Practical Nurse

March 7, 2025

Testimony on:

SB1080/Act137: Pronouncement of Death by a Practical Nurse

Pennsylvania State Board of Nursing

 March 6, 2025

Presented by:

Mia Haney

CEO, Pennsylvania Homecare Association
 Executive Director of the Pennsylvania Association of HCBS Providers

Anja Miller

Director of Guthrie Hospice in Northeast Pennsylvania

Amy Hart

Dedicated Hospice LPN for Guthrie Hospice

Contact Information:

Pennsylvania Homecare Association

Mia Haney, CEO
 MHaney@pahomecare.org

Introduction (Mia Haney)

Good morning, Chairman Hunsberger, members of the Board, and all those in attendance. Thank you for the opportunity to speak today about the implementation of SB1080, also known as Act 137 of 2024.

My name is Mia Haney, and I am the CEO of the Pennsylvania Homecare Association (PHA).  The Pennsylvania Homecare Association (PHA) is a nonprofit trade organization representing more than 700 home care, home health and hospice agencies across the Commonwealth. These agencies provide essential care to hundreds of thousands of Pennsylvanians each year, delivering services in all 67 counties—directly in patients’ homes, the most cost-effective and preferred care setting.

PHA recently championed a common-sense policy change to address a longstanding challenge in home-based hospice care. Under the Vital Statistics Law of 1953, the authority to pronounce death in a home hospice setting was limited to registered nurses (RNs), physicians, physician assistants, and coroners. Our goal was to modernize this law by extending this authority to licensed practical nurses (LPNs), a practice successfully implemented in other states, including Virginia.

This effort serves two critical purposes:

  1. Providing compassionate support to grieving families—By allowing an LPN who is already present and delivering end-of-life care to pronounce death, we reduce unnecessary delays, eliminate administrative burdens, and enable families to focus on mourning rather than logistics.
  2. Ensuring efficiency amid a nursing shortage—Given the critical shortage of nurses, particularly in rural areas, it is both practical and necessary to permit an LPN—who is already on-site and deeply involved in the patient’s care—to pronounce death. This prevents delays caused by waiting for an RN or coroner to travel to the home, often hours later, simply to confirm what is already known.

Key safeguards are built into the legislation to ensure that LPNs performing this function receive ongoing training in death pronouncement, vital signs assessment, postmortem care, grief support, and identifying circumstances requiring a coroner’s involvement.

It is important to clarify that LPNs are not expressly prohibited from pronouncing death under the applicable scope of practice law. However, Act 137 of 2024 provides the State Board of Nursing with the option to establish regulations within 18 months of the law’s effective date. Today, we ask the Board to consider two possible paths forward:

  1. Recognize that additional regulation is not required for this law to be implemented as written. The statute states that regulations may be promulgated by the Board, but they are not mandated.
  2. If regulatory action is pursued, ensure it is expedited to prevent unnecessary delays that waste valuable nursing resources and, more importantly, add to the burden of grieving families.

Since the law’s passage, no formal guidance has been issued suggesting that implementation should be delayed. The legislation specifies that it takes effect 60 days after enactment, which concluded on December 31, 2024. In the absence of guidance to the contrary, it is reasonable for licensed hospice agencies to proceed with implementation.

If this Board intends to develop regulations, we urge that process to move swiftly, and that guidance be released promptly. However, we strongly support a path that does not require changes to the scope of practice. Instead, the Vital Statistics Act has been appropriately amended through Act 137 and should be implemented without delay.

To further illustrate the real-world impact of this legislation, I am honored to introduce Anja Miller, Director of Guthrie Hospice in northeast Pennsylvania, and Amy Hart, a dedicated Hospice LPN. They will now share their firsthand experiences of how this change will positively affect hospice agencies and the patients they serve.

Practical Implementation (Anja Miller and Amy Hart)

  • (Anja) Providing Emotional Support – Families rely on healthcare professionals for guidance and compassion during this difficult time. LPNs, already present at the bedside, are well-positioned to communicate death pronouncements with sensitivity and professionalism. Grieving families experience profound emotional distress, and timely pronouncement is essential in providing closure and support.
  • (Amy) Example 1: An LPN made a PRN visit in the middle of the night and, upon arrival, found that the patient had passed. However, the LPN was required to call an RN to officially pronounce death, delaying the removal of the body for several hours. This extended wait caused additional distress for the family, who struggled with having their loved one remain in the home for an unnecessary length of time.
  • (Amy) Example 2: An LPN visited a Navy veteran of the Gulf War and observed that the patient was minutes away from taking his final breath. The nurse provided critical emotional support to both the patient and the family during this sacred moment. However, after the patient passed, the LPN was unable to pronounce death, requiring an RN to be called. Because the area is rural and the available RNs were out seeing other patients, there was a significant delay. The LPN had to contact the clinical director, an RN, who had to leave an important meeting to fulfill this requirement. This disruption and delay could have been avoided if LPNs were permitted to pronounce death, as approved in SB 1080. Hospice only gets one chance to handle these moments correctly—we must ensure we do it right, even after death.
  • (Anja) Ensuring Dignity for the Deceased – Delays in pronouncing death not only cause distress for families but also impact the dignity of the deceased. LPNs are trained to manage these situations with professionalism, respect, and adherence to proper protocols, ensuring a smooth and compassionate transition for grieving loved ones.

Conclusion (Mia Haney) 

As my colleagues have emphasized, this legislation presents a practical, compassionate solution by allowing highly trained and dedicated Licensed Practical Nurses (LPNs) to pronounce a patient’s passing. This change removes administrative burdens, streamlines processes, and ensures that families can focus on grieving without unnecessary delays.

Pennsylvania is facing a critical nursing shortage, with a projected shortfall of approximately 20,000 nurses by 2026. As hospices work to meet the increasing demand for end-of-life care among an aging population, it is essential to adopt policies that optimize our existing workforce. This legislation is a measured, responsible step in that direction.

LPNs already play a vital role in hospice care, including:

  • Reporting changes in a patient’s condition to the Medical Director
  • Recommending adjustments in visit frequency
  • Educating families on what to expect as their loved one’s condition progresses
  • Actively participating in the interdisciplinary hospice team, to make recommendations for needed supports —such as spiritual care, social work, or bereavement services—is needed.

Given these established responsibilities, this legislation is not a departure from current practice but a logical, common-sense enhancement that aligns with the critical role LPNs already fulfill in hospice care.

This law was passed with overwhelming bipartisan support in both chambers of the Pennsylvania General Assembly – a clear recognition of its importance to the home-based hospice industry and the families it serves. We respectfully urge the Pennsylvania State Board of Nursing to expedite its review of any regulatory considerations to ensure this law is fully enacted without unnecessary delay.

Importantly, this legislation already incorporates appropriate training requirements to uphold patient safety and professional competency. Further delays would only add unwarranted strain on hospice agencies and the families they support.

We appreciate your prompt attention to this matter and we look forward to working together to ensure that Pennsylvania’s home-based hospice patients and their families receive the compassionate, timely, and dignified care they deserve.

Question & Answer