CARF Palliative and End-of-Life Care Accreditation: Case Study

[Organization Name] — [State]

Last updated: April 2026

This case study describes how IHS guided [Organization Name], a [CCRC / assisted living and memory care community / home health agency / hospice organization] in [State], through CARF Palliative and End-of-Life Care (PELC) Specialty Program designation — achieved in conjunction with [Three-Year / Two-Year] CARF [CCRC / Aging Services] Accreditation in [Month Year] after [X] months of consulting engagement.

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Client Profile

Organization type: [CCRC / Assisted Living and Memory Care Community / Home Health Agency with Palliative Care Program / Hospice Organization]
State: [State]
Residents/clients served: [X] individuals, of whom approximately [X] received PELC services annually
PELC program scope: [Inpatient palliative care / home-based palliative care / community palliative care / hospice]
Base CARF accreditation: [CCRC / Aging Services / Medical Rehabilitation — current through [Month Year]]
Prior PELC designation: [First-time PELC / Renewal]
Engagement duration: [X] months

Situation at Engagement Start

[Organization Name] had held CARF [base program] accreditation for [X] years when leadership identified the PELC Specialty Program designation as a strategic priority. The drivers were [select as applicable: board quality initiative / mission alignment with comfort-centered care values / competitive differentiation in the aging services market / strategic response to increasing end-of-life care demand in the resident/client population].

At the start of the IHS engagement, [Organization Name] had palliative care services that were valued by residents/clients and families, but not organized as a CARF-compliant PELC program. Specific gaps included:

Interdisciplinary team structure: [Palliative care was delivered by a physician/NP and nursing, with chaplaincy and social work involved on a consultant basis. A formal IDT meeting structure did not exist — care decisions were made individually and communicated through chart notes. No documented IDT meeting minutes or care decision records existed.]
Advance care planning system: [Advance directives were documented when residents/clients or families initiated the conversation. No organized system existed for proactive ACP initiation at program entry, and no process for updating ACP documentation as conditions changed was in place.]
Spiritual care integration: [Chaplaincy was available and actively used, but spiritual assessments were not conducted using a structured tool, and spiritual care findings were not incorporated into IDT care planning. Chaplaincy operated independently of the clinical team.]
Symptom assessment: [Nurses assessed symptoms through clinical observation and patient/family report, but no validated standardized tools (ESAS, PPS, or comparable instruments) were used at defined intervals. No documented symptom management protocols existed for common palliative symptoms.]
Family assessment and support: [Family communication was frequent and valued by families, but family needs were not formally assessed at program entry. Family support activities were not documented in clinical records.]
Bereavement program: [Staff provided informal bereavement support to families after resident/client deaths — condolence cards, brief follow-up calls. No organized bereavement program existed with bereavement risk assessment, structured follow-up timelines, or referral protocols.]
Outcome measurement: [Individual clinical outcomes were documented in records but not aggregated at the PELC program level for QI analysis.]

IHS Approach

Phase 1: Gap Assessment ([Month Year] – [Month Year])

IHS conducted a systematic gap assessment against current CARF PELC standards, reviewing [Organization Name]'s existing palliative care policies, clinical records for a sample of [X] recent PELC cases, chaplaincy documentation practices, staff training records, and quality improvement data. The assessment identified [X] gaps across [X] PELC standard sections, with a prioritized remediation roadmap.

Phase 2: Program Architecture ([Month Year] – [Month Year])

IHS developed and established:

IDT structure and meeting protocol: team composition, meeting frequency and format, meeting documentation template (attendance, agenda, care decisions, follow-up items), and communication procedures with referring/treating providers
Advance care planning system: ACP initiation protocol for new admissions; goals-of-care conversation documentation template; ACP review trigger protocol; cross-setting accessibility procedure
Spiritual assessment tool (adapted [validated instrument — e.g., FICA, HOPE]) and procedure for incorporation of spiritual care findings into IDT care planning
Symptom assessment protocol: [ESAS / PPS / organization-selected validated tool] implementation at admission, weekly, and at condition change; symptom management protocols for pain, dyspnea, nausea, anxiety, and delirium
Family assessment instrument at PELC program entry; family support documentation procedure integrated into clinical record
Bereavement program structure: bereavement risk assessment at time of death; tiered follow-up protocol (low/moderate/high risk); condolence outreach, bereavement follow-up call schedule, and referral pathway to community grief support; bereavement program documentation system
PELC outcome measurement dashboard: ESAS admission/discharge comparison, goal-of-care achievement tracking, family satisfaction instrument, place of death documentation, and QI reporting cycle

Phase 3: Implementation Support ([Month Year] – [Month Year])

IHS provided monthly consultation during the [X]-month implementation period supporting: [X] IDT meetings facilitated to establish meeting cadence and documentation practice; training of [X] clinical and chaplaincy staff in spiritual assessment tool use; ESAS rollout with [X] nursing staff; bereavement program launch with [X] families in the first program cohort; and first full PELC QI data analysis cycle.

Phase 4: Mock Survey ([Month Year])

IHS conducted a focused PELC mock survey component — reviewing [X] PELC case records, conducting IDT meeting observation, interviewing [X] IDT members, [X] families of current PELC participants, and [X] bereaved family members. The mock survey identified [X] remaining gaps — primarily in [specify: IDT documentation completeness / ACP update compliance / bereavement follow-up documentation]. IHS supported resolution of all remaining gaps within [X] weeks before the actual CARF survey.

Survey Outcome

[Organization Name] received its CARF survey in [Month Year], conducted by [X] surveyor(s) over [X] days, with PELC specialty review integrated into the base [CCRC / Aging Services] survey. [Organization Name] achieved [Three-Year / Two-Year] CARF Accreditation with PELC Specialty Program designation, effective [Month Year].

Key Survey Findings

Strengths noted by surveyors: [e.g., The bereavement program was cited as a program strength — surveyors noted that the tiered follow-up protocol and bereavement risk assessment demonstrated a structured, evidence-informed approach to family support that exceeded what surveyors typically observe in aging services settings.]
Areas of conformance: [e.g., The IDT meeting documentation demonstrated genuine collaborative decision-making — care decisions in meeting minutes were consistent with subsequent clinical record entries, and IDT members interviewed could describe how team decisions were made and implemented.]
Quality Improvement Plan requirements: [None / The organization received a QIP requirement in [standard area], which IHS supported the organization in resolving within [X] weeks of survey.]

Results and Impact

Accreditation achieved: CARF [Three-Year / Two-Year] Accreditation with PELC Specialty Program designation — [Month Year]
Clinical outcomes: [e.g., Program-level ESAS data showed average symptom burden score decreased from [X] at admission to [X] at discharge/death — demonstrating measurable symptom management effectiveness for the first time]
Goal-of-care achievement: [e.g., [X]% of persons served died in their preferred setting per documented ACP goals, up from estimated [X]% prior to ACP system implementation]
Family satisfaction: [e.g., Family satisfaction scores averaged [X]/10 in the first post-accreditation survey cycle; [X]% of families rated communication with the IDT as "excellent"]
Bereavement program reach: [e.g., [X]% of bereaved families received structured bereavement follow-up within [X] weeks of death in the first [X] months of program operation]
Market impact: [e.g., PELC designation featured in [Organization Name]'s marketing materials and referenced in [X] prospective resident/family inquiries as a factor in community selection]

From the Client

"[Client quote — placeholder for actual client statement about the IHS engagement and CARF PELC designation outcome.]"
— [Name], [Title], [Organization Name]

Ready to Pursue CARF Palliative and End-of-Life Care Accreditation?

IHS guides CCRCs, assisted living communities, home health agencies, and palliative care programs through every phase of CARF PELC Specialty Program accreditation. Led by Thomas G. Goddard, JD, PhD, former COO and General Counsel of URAC, with over 25 years of healthcare accreditation expertise.