What changed for caregivers this week — October 5, 2026

A strike at a California hospice raises questions about care continuity, CMS adds a new disclosure requirement for hospice enrollment, a bipartisan bill would expand PACE access under Medicaid, and a proposed CMS rule could bring palliative care into the Medicare home health benefit — a week where the structures families depend on at the hardest moments were visibly under strain.

Seventy workers at Hospice East Bay went on strike Monday — families currently receiving care there need to know what that means

Seventy workers at Hospice East Bay — including nurses, social workers, chaplains, bereavement counselors, and pharmacists — launched a seven-day strike on Monday, according to Hospice News. The strike covers a significant share of the clinical and support staff responsible for direct patient and family care at one of the larger nonprofit hospices serving the East Bay region of California.

For families currently enrolled in Hospice East Bay services, the immediate practical question is whether care will continue uninterrupted. Hospices facing a strike typically bring in replacement staff or contract workers to maintain coverage, but the quality and continuity of that coverage — particularly for the relationship-dependent work that chaplains, social workers, and bereavement counselors do — is not guaranteed to be equivalent. A family whose parent or spouse is currently receiving Hospice East Bay services should call their assigned care coordinator today and ask directly: who will be providing visits this week, are any scheduled visits being rescheduled, and who is the point of contact if something changes overnight. If the answers are unsatisfactory or the family loses confidence in the continuity of care, they have the right to request a transfer to another hospice provider — a process that can be initiated by calling the hospice's patient services line or by contacting the California Department of Public Health, which licenses hospice providers in the state. The seven-day duration means the situation may resolve before the week is out, but families should not wait to ask questions.

CMS now requires hospices to give patients a new disclosure document at enrollment — and families should know what it says and why it exists

A new federal requirement took effect last week: Medicare-certified hospices must now provide every patient with an addendum to the hospice election statement at the time of enrollment. CMS has granted a short grace period for hospices still coming into compliance, according to Hospice News. The addendum is designed to give patients and families a clearer picture of what the hospice benefit does and does not cover — specifically, which conditions and treatments are considered related to the terminal diagnosis and therefore covered by hospice, and which are not.

This requirement exists because the line between what hospice covers and what it does not has historically been a source of confusion and, in some cases, unexpected out-of-pocket costs for families. A person enrolled in hospice for heart failure, for example, may have other conditions — a wound, a fall injury, a separate chronic illness — and the question of whether treatment for those conditions is covered under the hospice benefit or billed separately has not always been communicated clearly at enrollment. The addendum is meant to make that explicit before a family signs anything. If a family is currently in the process of enrolling a parent or spouse in hospice, ask the intake coordinator to walk through the addendum line by line rather than treating it as a signature formality. The specific conditions listed as related to the terminal diagnosis — and therefore covered — are worth understanding before care begins, not after a bill arrives.

A bipartisan bill would require Medicaid to cover PACE in every state — and families caring for someone with complex needs should understand what PACE actually offers

Representatives Debbie Dingell and John Moolenaar of Michigan introduced a bill this week that would make the Program of All-inclusive Care for the Elderly mandatory under Medicaid and allow PACE providers to expand into new markets, according to Home Health Care News. Currently, PACE is an optional Medicaid benefit, meaning states can choose whether to offer it — and not all do. The bill would change that, requiring every state Medicaid program to make PACE available and creating incentives for providers to open programs in areas that currently have none.

PACE is one of the least-known and most comprehensive care options available to older adults who meet nursing-home-level care criteria but want to remain at home. A PACE participant receives all of their medical care — primary care, specialist visits, physical therapy, medications, dental, transportation, and adult day services — coordinated through a single interdisciplinary team and funded jointly by Medicare and Medicaid. For a family currently managing a parent with multiple chronic conditions, frequent hospitalizations, and a patchwork of providers who do not communicate with each other, PACE is the structural alternative to that fragmentation. The catch is availability: PACE programs exist in 32 states and the District of Columbia, and even within those states, geographic coverage is uneven. Whether this bill passes before the end of the session is uncertain — the legislative calendar is short — but families who want to know whether a PACE program exists in their area can search by zip code at pace4you.org.

CMS has proposed adding palliative care as a billable service under the Medicare home health benefit — a change that would matter for families managing serious illness at home

A proposed CMS rule would allow Medicare-certified home health agencies to bill for palliative care services delivered in the home, building palliative care formally into the home health benefit for the first time, according to Home Health Care News. Under the current structure, palliative care — which focuses on symptom management, goals-of-care conversations, and quality of life for people with serious illness — is not a reimbursable service under the Medicare home health benefit. Agencies that provide it do so by absorbing the cost or through separate funding, which limits how widely it is offered.

For families, the practical significance of this proposal is about access. Palliative care does not require a person to give up treatment or enroll in hospice — it can and should run alongside curative or disease-modifying treatment. But for a family whose parent is managing cancer, advanced heart failure, COPD, or another serious illness at home, getting a palliative care team involved has often meant navigating a separate referral, a separate set of providers, and a benefit structure that does not cover the cost. If this rule is finalized, home health agencies would have a financial basis to offer palliative care as part of the care they are already delivering in the home. The proposed rule is open for public comment — the Federal Register notice will include the comment deadline and submission instructions, and any family member with direct experience of the gap this rule is trying to close can submit written input. The Center to Advance Palliative Care at capc.org maintains a provider directory that can help families identify what palliative care services are currently available in their area while the rulemaking process continues.

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