Hospice & Palliative Care Today

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Welcome to Hospice & Palliative Care Today, a daily email summarizing numerous topics essential for understanding the current landscape of serious illness and end-of-life care. Teleios Collaborative Network podcasts review Hospice & Palliative Care Today monthly content - click here for these and all TCN Talks podcasts.

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March 28th, 2026

Saturday newsletters focus on headlines and research - enjoy!

* CEO, Hildegard House, Louisville, KY

Contents

Research News

   1. Changes in RI hospice utilization and quality of care with increase in number of hospice programs
   2. State POLST program maturity status and dying in the nursing home or hospice in the United States: An event time study
   3. Ethical uncertainties: Diverging and emerging regulations of assisted dying/assisted suicide and the potential role of clinical ethics
   4. Decision-making approaches used to limit potentially nonbeneficial life-prolonging interventions
   5. Nursing home profit status and pain among residents living with dementia
   6. Accountable Care Organization savings—Hard to measure, hard to find
   7. Characteristics of United States Food and Drug Administration drug recalls involving opioid medications, 2002-2025
   8. Rapid review of the health care built environment support for hospice/end-of-life patients, families, and interdisciplinary care teams
   9. Billing of Medicare’s G2211 longitudinal care code among traditional Medicare beneficiaries
   10. Feasibility and acceptability of a self-written, tele-delivered, LGBTQ+-affirming adaptation of dignity therapy for LGBTQ+ women with advanced cancer

International News

11. [Canada] Exploring the factors that prevent or facilitate palliative care at ‘home’ for adults experiencing structural vulnerability: A scoping review
12. [UK] Assessing the inclusion of music therapy and music interventions in national dementia strategies and clinical practice guidelines: A scoping review

Today's Encouragement

13. Life is 10% ...

Research News

Changes in RI hospice utilization and quality of care with increase in number of hospice programs
Journal of Pain and Symptom Management; by Joan Teno; 3/26
The number of licensed hospice programs in Rhode Island increased from four prior to 2017 to eleven by 2025, with many new providers being for-profit entities, some backed by private equity. Using public data, I analyzed trends in hospice use and quality, hypothesizing that the growth in providers may increase health care costs and raise concerns about the quality of care. Using public data, I analyzed trends in hospice use and quality, hypothesizing that the growth in providers may increase health care costs and raise concerns about the quality of care... Compared to not-for-profit hospices, for-profit providers showed significant differences in several measures, including a higher focus on enrolling patients with dementia—a population that may be more profitable because of their long length of stay and higher live discharge rates. A four-point difference in bereaved caregiver willingness to recommend for profit hospices indicates a moderate effect size and raises concerns about quality.

State POLST program maturity status and dying in the nursing home or hospice in the United States: An event time study
Journal of the American Medical Directors Association; by Komal Patel Murali, May Hua, Patricia W Stone, Andrew Dick, Tadeja Gracner; 2/26
State Physician Orders for Life-Sustaining Treatment (POLST) programs ensure documentation of orders for treatment are documented for the provision of goal-concordant care at the end of life. The national POLST organization tracks the maturity stages of state programs and categorizes them as developed (beginning of use) and endorsed (benchmarks and standardized use). Examining the association between POLST program maturation and the likelihood of dying in place can help clarify how implementation stage may affect end-of-life care and place of death. POLST program maturity is associated with a higher likelihood of NH residents dying in place or in hospice, potentially supporting goal-concordant care and reducing burdensome hospital transfers near the end of life.

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Ethical uncertainties: Diverging and emerging regulations of assisted dying/assisted suicide and the potential role of clinical ethics
Bioethics; by Katherine Wasson, Kathleen Benton, Karin Bruckmüller, Melissa Gaule, Pola Hahlweg, Ralf J Jox, Renzo Pegoraro, Anne Slowther, Stella Reiter-Theil; 3/26
Assisted Suicide (AS)/Assisted Dying (AD), where a physician prescribes lethal medication to a terminally ill patient who intends to take it to end his/her life, is a highly controversial matter. Sound knowledge about recent legal changes and related challenges should inform considerations for clinical ethics consultation, education, and policy making. This article describes a wide spectrum of current legal contexts for AS/AD in the United Kingdom, Italy, Austria, the United States (US), Switzerland, and Germany. This selection includes countries covering a wide range from the restrictive to the permissive extreme as well as legal gray zones of AS/AD law and practice. Agreement exists that the knowledge and skills of CES [clinical ethics support] are valuable for identifying and analyzing moral issues and informing policy development and education at the individual case, institutional, regional, and national levels.

Assistant Editor's note: In this country, the term "assisted suicide" is not used. The common term used in the U.S. is "Medical Aid in Dying" (MAID) which is very descriptive of the activities and the intention involved in the practice.

Decision-making approaches used to limit potentially nonbeneficial life-prolonging interventions
JAMA Network Open; by Jason N. Batten, Sofia Weiss Goitiandia, Julia K. Axelrod, Helen O. Chernicoff, Ariadne A. Nichol, Lorraine M. Pereira, Jacob A. Blythe, Jacqueline M. Kruser, Elizabeth W. Dzeng; 2/26

Concerns about the default use of life-prolonging interventions have been raised in medical and lay press, especially for patients with chronic critical illness or nearing the end of life. In this multi-institutional qualitative study, respondents reported facing challenges limiting interventions using the approaches recommended in professional society policy statements (ie, shared decision-making and institutional processes addressing disagreement with patients and surrogates). Use of alternate approaches (eg, stating a plan to limit interventions, explicitly not offering interventions, and not mentioning interventions) can be viewed as pragmatic attempts to navigate decision-making challenges surrounding life-prolonging interventions. Strategies are needed to help clinicians balance the ethical ideals articulated in professional societal policy statements with the potential harms imposed by the default tendency toward life prolongation in US hospitals.

National Partnership for Healthcare and Hospice Innovation (NPHI)

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Nursing home profit status and pain among residents living with dementia
Pain Management Nursing; by Sorah Levy, Barbara Resnick, Elizabeth Galik, Kelly Doran, Tara McMullen, Sarah Holmes; 2/26
Nursing home (NH) residents living with dementia experience pain that is often sub-optimally managed. Nearly one in five nursing home residents with dementia experience pain symptoms.There is a known relationship between NH organizational factors, such as profit status, and quality of care. However, little attention has been paid to understanding the relationship between NH ownership profit status and pain among residents living with dementia. NH ownership profit status was not significantly associated with pain ...

Accountable Care Organization savings—Hard to measure, hard to find
JAMA Health Forum; by Adam A. Markovitz, Andrew M. Ryan; 2/26

The MSSP [Medicare Shared Savings Program] stands at the center of Medicare’s shift toward value-based payment, making it critical to understand whether the program delivers real savings. As the program has matured, evaluating its impact has become increasingly complex: small underlying effects, layered selection patterns, and changes in diagnostic coding create challenges even for the most rigorous analyses. These dynamics help explain why MSSP evaluations vary widely and why modest positive findings warrant caution. The present study offers a transparent attempt to estimate net savings but ultimately relies on fragile savings estimates shaped by selection and risk upcoding. Despite widespread enthusiasm for the MSSP, the evidence to date offers little indication that the program has delivered meaningful savings to Medicare.

Sponsor of Hospice & Palliative Care Today

Characteristics of United States Food and Drug Administration drug recalls involving opioid medications, 2002-2025
Pharmacoepidemiology and Drug Safety; by Julio C Nunes, Gabriel P A Costa, Joao P De Aquino; 3/26
We reviewed more than 20 years of recall data from the United States Food and Drug Administration and found 286 recalls involving seven commonly used opioids, affecting over 350 million tablets, capsules, patches, and injectable products. Nearly half of these recalls occurred because products failed basic quality checks, while others involved incorrect doses, contamination, mislabeling, or defective delivery systems. The most serious recalls, those carrying risk of serious injury or death, were concentrated among fentanyl, morphine, and hydromorphone. Many recall notices lacked important details, including the number of units affected, making it difficult to understand how these issues may impact patients. Our findings show that opioid recalls happen regularly and often reflect manufacturing problems that could influence treatment safety or effectiveness.

Rapid review of the health care built environment support for hospice/end-of-life patients, families, and interdisciplinary care teams
Journal of Hospice & Palliative Nursing; by O’Hara, Susan; Knill, Kathryn; Courville, Karolyne; Kiumarsi, Adrian; Hazra, Srinjoy M. Arch; Cheng, Zining; Calabrese, Evon; Mason, Jennifer E.; Morrison-Beedy, Dianne; 2/26

The health care built environment directly impacts health outcomes and the care experience of the patient and family members. Elements of the built environment include the architectural design, spatial organization, and physical features of clinical spaces that shape workflow, communication, and safety. This rapid review explores the role of the health care built environment in shaping hospice care delivery and supporting patients, families, and interdisciplinary teams in adapting approaches that promote comfort and quality of care. Evidence of the impact of the built environment and adaptations for hospice delivery is lacking. Given their unique perspective on day-to-day encounters, hospice and palliative care nurses can significantly shape the built environment.

Louisiana ~ Mississippi Hospice & Palliative Care Organization (LMHPCO)

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Billing of Medicare’s G2211 longitudinal care code among traditional Medicare beneficiaries
JAMA; by Ishani Ganguli, Nicholas E. Daley, Andrew L. Hicks, J. Michael McWilliams, Meredith B. Rosenthal; 2/26

In January 2024, Medicare introduced the G2211 billing code to the Physician Fee Schedule, which specifies payment rates for traditional (or original) Medicare and is also used by most other payers. Although Medicare cannot restrict codes to certain specialties, this add-on code pays clinicians an extra $16 per evaluation and management visit for the longitudinal care typically provided by primary care physicians and in many cases by specialists, ie, “serving as the continuing focal point for all of the patient’s health care services needs” or providing “ongoing medical care related to a patient’s single, serious…or complex condition (eg, sickle cell disease)”. Using Medicare claims, this study examined G2211 billing patterns in its first year to understand its uptake, the extent to which G2211 use was consistent with these objectives, and, given efforts to better support primary care, how often G2211 payments went to primary care specifically.

Feasibility and acceptability of a self-written, tele-delivered, LGBTQ+-affirming adaptation of dignity therapy for LGBTQ+ women with advanced cancer
American Journal of Hospice & Palliative Medicine; by Lexie Wille, Kristie A. Wood, Mike C. Parent; 2/26
Dignity therapy (DT) is effective in addressing dignity-related existential distress in people with advanced cancer, but the traditional protocol assumes supportive family structures, uses heteronormative language, and requires synchronous clinician facilitation. These features may limit accessibility for LGBTQ+ individuals. This pilot demonstrated that a self-written, tele-delivered LGBTQ+-affirming DT adaptation was feasible and acceptable for LGBTQ+ women with advanced cancer.

Sponsor of Hospice & Palliative Care Today

International News

[Canada] Exploring the factors that prevent or facilitate palliative care at ‘home’ for adults experiencing structural vulnerability: A scoping review
International Journal for Equity in Health; by Alexandra Stewart, Ami Bitschy, Katherine Kortes-Miller, Kristina Smith, Zahra Premji, Alexandra Grillo, Kelli Stajduhar; 2/26

This scoping review aims to summarize the current literature on the factors that facilitate or prevent palliative care at ‘home’ for structurally vulnerable adults. This review underscores that people experiencing structural vulnerability are too often denied the choice of where they die. Addressing inequities in end-of-life care requires policy reforms that support flexible service models and recognize diverse forms of home, including shelters, transitional housing, and supportive housing, as legitimate places of care and dying. Findings provide an evidence base to inform equity-oriented policies aimed at expanding end-of-life options for structurally vulnerable populations.

Assistant Editor's note: "Structurally vulnerable" is a new term for me. In the US we usually refer to it as, "people experiencing homelessness", or the "unhoused". The Canadian authors may call it something different, but this is also an issue in our country and the authors' comments apply here as well.

[UK] Assessing the inclusion of music therapy and music interventions in national dementia strategies and clinical practice guidelines: A scoping review
Healthcare; by Victoria McArthur, Martyn Patel; 2/26

Dementia prevalence is rapidly rising; currently it is estimated that over 55 million people have dementia, and this is predicted to increase to over 130 million cases by 2050. Over the past two decades, there has been a shift away from pharmacological management of BPSD [behavioural and psychosocial symptoms of dementia] due to limited efficacy and well-documented risks, including increased falls, stroke and mortality. Consequently, clinical guidance now emphasises person-centred, non-pharmacological interventions as first-line approaches. Music therapy is a recognised clinical intervention delivered by trained professionals, while structured and informal music interventions may also be implemented by caregivers following appropriate training. Evidence suggests that MTAM [music therapy and music-based interventions] can reduce anxiety and distress, enhance engagement, and support emotional and cognitive functioning in PWD [people with dementia].

Sponsor of Hospice & Palliative Care Today

Today's Encouragement

Life is 10% what happens to you and 90% how you react to it. ~ Charles R. Swindoll

The Fine Print:
Paywalls: Some links may take readers to articles that either require registration or are behind a paywall. Disclaimer: Hospice & Palliative Care Today provides brief summaries of news stories of interest to hospice, palliative, and end-of-life care professionals (typically taken directly from the source article). Hospice & Palliative Care Today is not responsible or liable for the validity or reliability of information in these articles and directs the reader to authors of the source articles for questions or comments. Additionally, Dr. Cordt Kassner, Publisher, and Dr. Joy Berger, Editor in Chief, welcome your feedback regarding content of Hospice & Palliative Care Today. Unsubscribe: Hospice & Palliative Care Today is a free subscription email. If you believe you have received this email in error, or if you no longer wish to receive Hospice & Palliative Care Today, please unsubscribe here or reply to this email with the message “Unsubscribe”. Thank you.