And for hospice volunteers, we have worked with experts to provide training on how to help hospice patients with everyday tasks such as shopping, bathing and dressing. And for state surveyors who inspect hospices for compliance with health and safety regulations, we have conducted special training sessions, as well. For example, one such session in 1997 included a presentation on effective symptom control, quality care for the terminally ill, and quality of life indicators that surveyors need to take into account by Ira Byock, M.D., who is also testifying at today's hearing. Living wills specify individuals' desired medical decisions in case they are incapacitated and cannot speak for themselves. Proxy appointments and durable power of attorney attestations designate someone else to make medical decisions in case an individual becomes incapacitated.
Individuals have the right to elect or decline to complete an advance directive.
However, the Patient Self Determination Act of 1990 mandates that all institutions receiving Medicare and Medicaid funding inform patients of their right to accept or refuse medical treatment through an advance directive. And, the Balanced Budget Act requires that the advance directive be placed in a prominent place within the individual's medical record. PROs hold state-level contracts with Medicare across the country to help promote quality care. In such projects, they would try to improve ways of controlling pain, providing comfort to patients, evaluating patient and family perspectives on quality of care, and measuring pain management. Medicare's Office of Clinical Standards and Quality also is providing technical assistance to hospice organizations in developing ways to measure the quality of care provided in hospices.