In memoriam: Dr. Robert Twycross
IAHPC press release; 10/21/24
The International Association for Hospice & Palliative Care (IAHPC) mourns the death of Dr. Robert Twycross, an outstanding pioneer of the global palliative care movement. A lifetime member of the IAHPC, Dr. Twycross made a significant contribution to the IAHPC List of Essential Medicines, developed years before the World Health Organization added a special section for essential medicines for pain relief and palliative care. Dr. Twycross was born on January 29, 1941, and died yesterday, October 22nd, 2024. He was a pioneer of the hospice movement, helping to establish palliative care in the 1970s as an accepted field of modern medicine.

YoloCares: State awards nearly $3 million to YoloCares 
The Enterprise; by Craig Dresang; 10/19/24 
In a move to expand and deepen the regional safety net for people facing a serious or life-limiting illness, Davis-based YoloCares recently applied for, and secured, a nearly $3 million commitment from the State of California to add an Enhanced Care Management component to its portfolio of offerings. By design, ECM intends to address the social determinants of health  which are the nonmedical factors that influence health outcomes. ... [As] Medi-Cal looks towards a major transformation in the structure of benefits, ECM is the Golden State’s initiative to address a lack of palliative and supportive care services.  ... According to Lisa Adams, YoloCares’ director of patient access and palliative care, “... This funding and recognition from the state simply acknowledges and supports the work we have been doing all along.”

The powerful companies driving local drugstores out of business 
DNYUZ; 10/19/24 
The small-town drugstore closed for the last time on a clear and chilly afternoon in February. Jon Jacobs, who owned Yough Valley Pharmacy, hugged his employees goodbye. He cleared the shelves and packed pill bottles into plastic bins. Mr. Jacobs, a 70-year-old pharmacist, had spent more than half his life building his drugstore into a bedrock of Confluence, Pa., a rural community of roughly 1,000 people. Now the town was losing its only health care provider. Obscure but powerful health care middlemen — companies known as pharmacy benefit managers, or P.B.M.s — had destroyed his business. This has been happening all over the country, a New York Times investigation found. P.B.M.s, which employers and government programs hire to oversee prescription drug benefits, have been systematically underpaying small pharmacies, helping to drive hundreds out of business.

Hockey team helps with Hotcakes for Hospice at Oswego Elks Lodge 
Oswego County News Now, Oswego, NY; by Lauren Royce; 10/20/24 
People poured into the Elks Lodge on West Fifth Street in Oswego Sunday morning, happy to buy a breakfast and enjoy some pancakes, eggs, bacon and other staples with friends and family. It was all for a good cause. The Friends of Hospice in Oswego County (FOHOC) hosted its sixth annual Hotcakes for Hospice breakfast with the help of the SUNY Oswego men's hockey team. For head coach Ed Gosek, it is a way to give back to the community while honoring the memory of his wife, Mary, who died in hospice care in 2017. ... The Lakers were outside holding signs by Bridge Street and inside helping serve food and clean tables for guests. ... Elena Twiss, executive director of FOHOC, said that bringing in the hockey team was a great way to bring the community together, and that the players and coaches have been a valuable resource all six years they've helped out.

Enhabit Home Health & Hospice Becomes Age-Friendly Health Systems participant 
HomeCare, Dallas, TX; 10/21/24 
Enhabit Inc., a home health and hospice provider, announced it has been recognized by the Institute for Healthcare Improvement (IHI) as an Age-Friendly Health Systems participant. The Age-Friendly Health Systems is an initiative of the John A. Hartford Foundation and the IHI, in partnership with the American Hospital Association and the Catholic Health Association of the United States. The Age-Friendly Health Systems aims to follow a set of evidence-based practices, cause no harm and align with what matters to the older adult and their family caregivers. Age-Friendly Health Systems participants are recognized for aiming to become an Age-Friendly Health System and have submitted examples of how they put four elements of care—the “4Ms”—into practice with older patients. ...

• What Matters ...
• Medication ...
• Mentation ...
• Mobility ...

Poetry, again, confronts death 
JAMA; by Rafael CAmpo, MD, MA; 10/16/24
Poetry can help physicians in many ways at the border between life and death. Though we might think first of the consoling power of elegy in confronting mortality, other poems, like “Again,” [referenced] aid us in wrestling with what death is in the first place—and are even more useful when research falls short in attempting to demystify it. One such scientific controversy surrounds in-hospital resuscitation, especially for older adults, with studies showing inconsistent rates of meaningful survival after these potentially life-saving interventions, confounded by the physical and emotional trauma that accompanies them, poor understanding of patients’ and families’ wishes, unclear definitions of “meaningful,” and varying patient selection criteria. [The poem titled] “Again” distills some sense out of this complexity as only poetry can, with the urgent repetition of “again” expressing the ingrained imperative to act when patients experience cardiac arrest while echoing both the many previous resuscitations hospital staff well remember, along with the 2-beat, up-down muscle memory of performing chest compressions. ... Thus, a reflexive, futile endeavor becomes a human being’s dying moment, allowing us to feel closure. Debates around in-hospital resuscitation suddenly quieted, we recognize life’s inevitable finality, underscored by the poem’s ironically dignified resignation in its concluding line: “Never again did you wake.”
Editor's note: Click here to access the poem, "Again."

A special dedication for a Make-A-Wish room 
KOB-4, Albuquerque, NM; by KOB; 10/18/24 
There’s nothing like making a child’s wish come true. For children fighting a critical illness, those wishes are a gift of hope that can help give them the strength to continue their fight. Through tears and hugs, the Make-A-Wish room where wishes are planned and granted was dedicated to the memory of a Wish Kid.  ... “After two days in the hospital, we were able to bring our precious boy home. ...” It’s a situation no family prepares for after bringing their newborn home. ... Seth was placed on hospice and his family focused on letting him live out his best life. That’s when make a wish became part of his story. “They were pure magic from the moment we met them, after sitting down to meet and learn about Seth, we discussed possible wish ideas.” That meeting was done in the Wish Room. ... “Our Wish Room is where Wish Kids come in to do their discovery visits, to talk about their wish to plan. And so it’s a really fun space just for kids to come in, forget about their diagnosis for a while and dream big,” said Sara Lister, president & CEO of Make-A-Wish New Mexico.

A simple question changed how I saw my daughter’s life 
Newsweek Life; by Nikki Moberly; 10/20/24 
When my daughter was born almost 24 years ago, not only did I begin my journey as a first-time parent, I embarked on an odyssey that nobody could have prepared me for. This little girl with the face and disposition of an angel was born with a devastating condition, diagnosed at two-and-a-half months old with Aicardi Syndrome. ...  The first years of her life were laser-focused on learning more about her rare condition, symptom stabilization, medication adjustments, therapists, and doctor's appointments. Erin was eligible for early intervention services allowing her to go to school at age three. ... For one of those interviews, the social worker came to my home for us to complete Erin's "student profile" card. I was about to learn the power of a well-placed question. She started by simply asking: "What are Erin's strengths?" ... [Click on the title's link to continue this mother's journey through her daughter's life and death.]

3 strategies for hospice GIP compliance 
Hospice News; by Jim Parker; 10/21/24 
Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including ​for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare. ... Hospices and other stakeholders have developed a variety of methods, tools and resources for complying with GIP requirements. Among them, three key themes stand out.

• Understanding the requirements ...
• Effective documentation ...
• Be prepared ...

Martis Capital rumored to purchase Three Oaks Hospice’s in $150m deal 
Hospice News; by Holly Vossel; 10/18/24 
The private equity firm Martis Capital may soon acquire Dallas-based Three Oaks Hospice for a price tag ranging from $150 million to $160 million. Rumors of the potential sale appeared today in an Axios report, in which unnamed sources reportedly confirmed the deal. The Nashville-based investment and management company Petra Capital currently owns Three Oaks Hospice, which reportedly generates between $10 and $13 million in EBITDA, Axios indicated. Rumors that the hospice was considering a potential sale were first reported last month by the website Ion Analytics. The private-equity backed company provides hospice, palliative care and bereavement services across 28 locations in seven states. 

Help at Home to acquire Helpmates, Inc. 
The Daily Herald, Huntingdon, PA; 10/21/24 
Penn Highlands Healthcare and Excel Companion Care, LLC, doing business as Help at Home, have agreed to the acquisition of Helpmates, Inc., the health system’s non-skilled in-home services. Help at Home is a national in-home provider with a focus on unskilled personal care services. “The acquisition of Helpmates enables our health system to focus and grow the core services of Healthcare at Home which include home health and hospice,” said Cheryl Mitchell, Service Line Leader of Penn Highlands Healthcare at Home. ... The acquisition will occur on or around December 9, 2024 following governmental approval. 

Home health agencies may soon claim telehealth services during patients’ hospital stays 
McKnights Home Care; by Adam Healy; 10/17/24 
In a recent change, the Centers for Medicare & Medicaid Services announced that it would allow home health providers to submit claims for telehealth while their clients are receiving inpatient care. Currently, Medicare beneficiaries may not be inpatients in a hospital or skilled nursing facility and simultaneously receive home healthcare. CMS rejects any home health service claims that overlap with a patient’s hospital or SNF stay, and providers are responsible for submitting a new claim without any dates for service that coincide with an inpatient stay. In a recent change request, CMS announced that it would modify its rule to allow home health providers to submit telehealth claims even when their clients are in hospital or SNF care. The change specifically applies to telehealth services that fall under the G0320, G0321 or G0322 Healthcare Common Procedure Coding System codes. 

Home health care aide charged with manslaughter in death of elderly central Florida man 
West Orlando News, Orlando, FL; by Staff; 10/20/24
[This article updates the story we posted on 10/1/24, Polk County home health aide accused of sleeping on the job arrested in man’s death: ‘He was old anyway.']
... According to the affidavit, Taylor, who was employed by Assisting Hands Home Health Care as a health aide, worked the evening hours at the man’s home in Winter Haven. ...  He was also receiving services from Good Shepherd Hospice beginning on August 14, 2024. ... During an autopsy, it was discovered the patient had an implanted pacemaker. The device manufacturer was later able to conduct a download and provide cardiac data stored on the victim’s implanted pacemaker which confirmed that the victim was still alive at 1:00am when the victim was initially found by Taylor lying on the floor. According to the Medical Examiner, had Taylor called 9-1-1 when she first found the victim, as required by her own company’s policy, the victim would not have died. The Medical Examiner ruled the victim’s cause of death positional asphyxia with a contributory cause of pre-existing health issues. 

Florida health system rolls out virtual nursing tech to 1K rooms 
Becker's Health IT; by Giles Bruce; 10/17/24 
Fort Myers, Fla.-based Lee Health is expanding virtual nursing technology to nearly 1,000 patient rooms, representing about half its beds. The four-hospital system is rolling out dual-camera virtual care devices from telehealth company Caregility to scale its virtual nurse offering. The remote fleet management tools come with artificial intelligence capabilities and cloud-based updates. "Our virtual nursing program introduces innovative possibilities in patient care workflows by connecting the care in the complex patient journey," Lee Health Chief Nursing Officer Jennifer Higgins, DNP, RN, said in an Oct. 16 statement. "From admissions and discharges to continuous patient monitoring, patients benefit from an additional team member dedicated to their care."

Millennials are reporting a mysterious wave of memory problems. What’s going on? 
Globe Magazine, Boston, MA; by Felice J. Freyer; 10/21/24 
... Memory lapses are expected as we age, but there’s evidence that many younger people — in the prime of life, ages 20 to 50 — are losing their grip on thoughts, struggling to retain new information and retrieve old knowledge. Experts blame the way we live and the world we live in, abuzz with distracting technologies amid endless demands on our time and minds. Dr. Andrew E. Budson, a Boston University neurologist who specializes in memory disorders in older adults, runs into younger people whenever he gives a talk. Inevitably, someone in their 30s or 40s will approach him afterward with: My memory is terrible. . . . I know I’m young, but I’m concerned I’m getting Alzheimer’s disease. ... [Click on the title's link to continue reading.]

Aging Mastery: 10 weeks, 10 topics to empower seniors for healthy living 
New Hampshire Union Leaders; by Kathleen D. Bailey; 10/20/24 
Jen Brechtel, director of Community Health for the Granite VNA, said one of the biggest issues in the agency’s “Aging Mastery” program” is sleep. “It’s the topic people come in most for,” she said. “We partner with a sleep center to help them out. Another big one? Community engagement.” The Granite VNA and Hospice is interested in all factors affecting their senior clients. With a menu of data-driven programs, the agency is reaching out to help seniors master aging. The “Aging Mastery” program is a project of the National Council on Aging, according to Brechtel. ... The 10-week class, ongoing now in Sanbornton, has sessions devoted to the concepts that please (or plague) elders: navigating longer lives, exercise, sleep, healthy eating/hydration, financial fitness, advance planning, healthy relationships, medication management, community engagement and falls. Experts from the community take turns teaching the topics, with a VNA staffer as moderator.

October is a fallen leaf, but it is also the wider horizon more clearly seen. ~ Hal Borland