New standards advocate for the highest palliative and end-of-life care for persons served

Early integration of palliative care allows a program to address the cultural, physical, emotional, psychosocial, religious, and spiritual needs and preferences of the persons served. The program seeks to understand the values, beliefs, wishes, and end-of-life choices of the person served through advanced care planning and implementation of individualized, interdisciplinary care plans.

New standards process

CARF’s process for creating new standards involves conversations with interested parties before convening an International Standards Advisory Committee (ISAC) to discuss and develop the standards. The committee size ranges from 10 to 15 and consists of CARF staff and surveyors, key stakeholders, and individuals or family members with lived experience.

One committee member, Sheryl Johnston, RN, has 25 years of hospice palliative care experience in community nursing, then at an acute care and complex care hospital, and now working for a hospice organization as Director of Clinical Services and Informatics at The Hospice of Windsor and Essex County Inc. in Windsor, Ontario, Canada.

“My education and professional experience have equipped me with the expertise to serve as a subject matter expert and the confidence to advocate for the highest possible standards,” said Johnston. “My background enabled me to identify potential limitations in applying certain standards statements and to determine which standards are most relevant across different contexts, ensuring they are practical and achievable for a diverse range of organizations.”

PELC specialty program

The PELC specialty program provides or arranges for grief and bereavement supports, resources, and end-of-life care. The program educates providers across the continuum of care and advocates for underserved populations. It utilizes current research and evidence-based practices to provide effective care and support to persons served and their families/support systems. The program demonstrates the commitment, capabilities, and resources to comprehensively address the complex needs of persons with life-limiting illness across a variety of settings.

“I was impressed with how smooth and organized the ISAC process was. These subject matter experts were from various sectors and disciplines, each bringing a unique perspective,” said Johnston. “The CARF ISAC team would ask questions and allow group discussions and healthy debate. It seemed as though overnight the team would magically turn them into standards for the group to review and edit as appropriate. Each person’s contribution was valued, respected, and appreciated.”

Standards developed

CARF developed these standards as a resource for aging services providers and community stakeholders. Key areas of the standards include:

• Philosophy of palliative care
• Early integration
• Advance care planning for each person served
• Education that meets the needs of persons served and families/support systems
• Grief and bereavement supports and resources
• Holistic end-of-life support
• Competency-based training for personnel, including volunteers
• Ethical concerns related to palliative and end-of-life care situations
• Policy on medical assistance in dying

Seeking feedback

Once the ISAC has finished the standards creation, a review of the proposed standards and seeking expert insight from the International Advisory Council is completed, before conducting a public field review. The Palliative and End-of-Life Care ISAC and public field review involved 55 stakeholders, including individuals with lived experience and their family members.

“As the world’s population continues to age, we will see an increase in the need for these programs. CARF accreditation, led by peer surveyors, will assure the public that these accredited programs are held to the highest standards of quality and performance improvement in the specialty of PELC,” said Terrence Carolan, CARF managing director of Aging Services and Medical Rehabilitation.

The new standards are published in the 2025 standards manuals for Aging Services and Continuing Care Retirement Communities, and accreditation surveys using the standards began July 1, 2025. Accreditation for PELC demonstrates a program’s capability of addressing the diverse and potentially complex health needs of individuals with life-limiting illness and provides integrated, evidence-based, person-centered care.

“The field of PELC continues to evolve rapidly, and using CARF’s field-driven standards to achieve accreditation ensures that individuals with life-limiting illness are receiving evidence-based care from an interdisciplinary team at the time when it is needed most,” said Carolan.

Sparked interest in surveying

Involvement in the ISAC for Johnston, “gained new mentors and colleagues for me to reach out to with questions about what is happening in their organizations or region. It was through this advisory committee that I gained the connections and interest to become a CARF Surveyor. The training process was intensive, and I was able to practice the knowledge from the learning modules when I attended the in-person Survey Simulation Training at CARF’s headquarters.”

Johnston has been involved with three CARF surveys at her current employer, The Hospice of Windsor and Essex County. That knowledge, along with 25 years of hospice palliative care work, her continuous education, the ISAC experience, and becoming a CARF Surveyor, have all led to today, where she strives to improve early identification of anyone who would benefit from a palliative approach to care and improve early access to palliative care services for all populations, including underserved individuals and their families.

Standards share best practices

CARF’s standards introduce an established, international mechanism to share and adopt best practices to improve outcomes. Accreditation demonstrates to persons served, regulators, and payers that the organization offers a comprehensive array of services and supports designed to help persons served.

Devoted, dedicated professionals, CARF standards, services, and surveyors, as well as the more than 68,300 accredited programs and services supporting more than 13 million persons served annually, come together with a goal to enhance people’s lives.

Go to the CARF website if you are interested in learning more about becoming a CARF Surveyor, Aging Services accreditation, and the PELC standards.