Do Family and the DPOA Have to Join Your IDG? California Says They Get a Seat — If They Want It.

Another good question from our weekly webinar: “Are the family and the DPOA required to be part of the IDG?” It matters because California’s emergency regulations wrote the interdisciplinary team into the licensing rules for the first time — and the definition names the family, the patient’s representative, and the caregiver as team members. The answer: they have the right to be included, but they are not required to participate. The obligation runs one way — toward the hospice, not the family.

The Definition: Who Is on the Team

Title 22 CCR § 74800(a)(31) defines the interdisciplinary team as the hospice care team that “includes, but is not limited to”:

• (A) A physician and surgeon.
• (B) A registered nurse.
• (C) A social worker, marriage and family therapist, or a mental health counselor.
• (D) A volunteer.
• (E) A spiritual counselor.
• (F) The patient.
• (G) The patient’s family, if they so desire.
• (H) The patient’s representative, if applicable, if they so desire.
• (I) The patient’s caregiver, if applicable, if they so desire.

Notice the drafting. The first six members are listed without qualification — that is your required professional core, plus the patient. The last three all carry the same four words: “if they so desire.” That phrase is doing the work. Family, representative, and caregiver are team members by their own choice, not by regulatory mandate.

And the DPOA fits at (H). An agent under a durable power of attorney for healthcare is the classic “patient’s representative” — so the same rule applies: if the DPOA wants a seat at the table, the hospice must provide one; if they don’t, their absence is not a deficiency.

The Obligation Runs One Way

Read as a compliance matter, § 74800(a)(31) creates a duty for the hospice: your team structure must have room for the family, representative, and caregiver, and you must actually include them when they want in. Excluding a family that asked to participate is the violation. A family that declines is not.

That distinction matters at survey time, because the two situations look identical in a chart with no documentation: no family at the IDG meeting. One of those is a family exercising its choice; the other is a hospice that never offered. Which brings us to the practical point below.

The Workload Never Falls on Them

A related worry we hear: if the family or DPOA joins the team, do they take on the team’s regulatory duties — assessments, care planning, the 15-day reviews? No. Section 74864(b) draws this line explicitly: the “hospice employee members” of the interdisciplinary team — defined as the individuals under § 74800(a)(31) “that receive compensation from the hospice” — are the ones who must complete the comprehensive assessment and, under § 74868, develop and maintain the written plan of care.

So a participating family member is a voice in the process, not a responsible party under the regulation. Their presence adds input to the plan of care; it never adds duties to their side of the table — and their absence never subtracts from yours. The 48-hour, 5-day, and 15-day clocks belong to your compensated staff either way.

Survey-Proofing the Invitation: Document the Offer

The regulation does not prescribe a declination form — but remember the theme running through this entire rulebook: the surveyor’s question is no longer “was the care right?” but “can the record prove it?” Two habits close the gap:

• Document the invitation at admission. A short note: family/representative/caregiver informed of their right to participate in the interdisciplinary team — accepted or declined, with a date. If there is a DPOA, name them and record their choice specifically.
• Renew it at care-plan reviews. Circumstances change — a family that declined at admission may want in when the patient’s condition shifts. A one-line re-offer at IDG review keeps the record current and shows the door stayed open.

Neither takes more than a sentence in the chart. Both turn an unanswerable survey question — “why is the family absent from these meetings?” — into a documented choice.

The Bottom Line

Family and DPOA participation in the IDG is a right, not a requirement. The hospice must offer the seat and honor an acceptance; the family is free to decline, and their declination costs you nothing — as long as the record shows the choice was theirs. Keep the professional core intact, keep the invitation documented, and keep the regulatory workload where § 74864(b) puts it: on the people you pay. As always, this is general education, not legal advice — confirm specifics against the current rule text and your compliance counsel.