Literature Review

Four years and more than 200,000 deaths later: Lessons learned from the COVID-19 pandemic in US nursing homesHealth Affairs; by R. Tamara Konetzka, David C. Grabowski, Vincent Mor; 7/24Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020–23.

Just one small positive thought in the morning can change your whole day. ~Dalai Lama

Today's Heartwarming Story [MHPCA Hospice in Corrections]Per Facebook post: Over the past decade, the Missouri Hospice and Palliative Care Association has trained hundreds of residents of Missouri state prisons to become hospice volunteers, providing comfort and companionship to terminally ill peers. The newest group recently completed training at Farmington Correctional Center. Volunteers develop skills in helping with daily activities, practicing empathy and active listening, and learning to recognize and respond to patients’ spiritual and emotional needs.

Pennant’s home health, hospice growth ‘significantly ahead’ of prior expectationsHome Health Care News; by Audrie Martin; 8/7/24The Pennant Group Inc. (Nasdaq: PNTG) leaders highlighted the company’s significant home health growth Tuesday. They also teased continued expansion in the East Coast and elsewhere. “We are thrilled to report record-breaking second quarter results as we continue to experience momentum across all our service lines and create meaningful growth opportunities for local leaders and teams,” Pennant CEO Brent Guerisoli said during the company’s second-quarter earnings call. “Our financial performance and growth trajectory reflect the consistent efforts we have applied to every aspect of our business through our five key focus areas: leadership development, clinical excellence, employee engagement, margin and growth.” The Pennant Group is a holding company based in Eagle, Idaho, with independent operating subsidiaries that provide health care services through 117 home health and hospice agencies and 54 senior living communities across 13 states.

Fearless hospice patient takes joyrideWest Valley View (AZ); by Lin Sue Flood; 8/7/24Don Tamuty, a beloved former Madison Unified School District teacher, had one thing left on his bucket list. The 95-year-old shared with his hospice nurse, Monisha Roe, that he would love to ride in a driverless car. Monisha and the rest of Don’s Hospice of the Valley care team knew exactly how to fulfill that wish! They booked a driverless cruise on Waymo One to take Don out to a nice restaurant.

Rescue from above: How drones may narrow emergency response timesKFF Health News; by Michelle Andrews; 7/22/24Starting in September, if someone in Clemmons, North Carolina, calls 911 to report a cardiac arrest, the first responder on the scene may be a drone carrying an automated external defibrillator, or AED. “The idea is for the drone to get there several minutes before first responders,” such as an emergency medical technician or an ambulance, said Daniel Crews, a spokesperson for the sheriff’s office in Forsyth County, where Clemmons is located. The sheriff’s office is partnering on the project with local emergency services, the Clinical Research Institute at Duke University, and the drone consulting firm Hovecon. “The ultimate goal is to save lives and improve life expectancy for someone experiencing a cardiac episode,” Crews said.Publisher's note: As with all things tech, when and how might drones be used in hospice?

Violent dementia patients leave nursing home staffers and residents ‘scared to death’KFF Health News; by Jordan Rau; 8/9/24Violent altercations between residents in long-term care facilities are alarmingly common. Across the country, residents in nursing homes or assisted living centers have been killed by other residents who weaponized a bedrail, shoved pillow stuffing into a person’s mouth, or removed an oxygen mask. A recent study in JAMA Network Open of 14 New York assisted living homes found that, within one month, 15% of residents experienced verbal, physical, or sexual resident-on-resident aggression. Another study found nearly 8% of assisted living residents engaged in physical aggression or abuse toward residents or staff members within one month. Dementia residents are especially likely to be involved in altercations because the disease damages the parts of the brain affecting memory, language, reasoning, and social behavior.

The mountains are calling, and I must go. ~John Muir

Connected to the cloud at time of death: a case reportJournal of Medical Case Reports; by Isabel Straw, Claire Kirkby, Preethi Gopinath; 8/24Our case report provides the first clinical evaluation of autopsy practices for a patient death that occurs on the cloud. We question how autopsy practices may require adaptation for a death that presents via the 'Internet of Things', examining how existing guidelines capture data related to death which is no longer confined to the patient's body... Through this patient case we explore novel challenges associated with digital deaths including; (1) device hardware issues (difficult extraction processes, impact of pathological tissue changes), (2) software and data limitations (impact of negative body temperatures and mortuary radio-imaging on devices, lack of retrospective cloud data analysis), (3) guideline limitations (missing digital components in autopsy instruction and death certification), and (4) changes to clinical management (emotional impact of communicating deaths occurring over the internet to members of family). Publisher's note: An interesting article posing interesting questions about the impact technology has on death and the potential use / misuse of health information gathered by devices.

African American patient and caregiver attitudes and perceptions of community health workers as lay patient navigators in palliative care Annals of Palliative Medicine; by Olivia Monton, Shannon Fuller, Amn Siddiqi, Alison P Woods, Taleaa Masroor, Robert Joyner, Ronit Elk, Jill Owczarzak, Fabian M Johnston; 8/5/24 Underutilization of palliative care services, especially among African American patients with advanced cancer, remains an important public health problem. To address this gap, we developed a community health worker (CHW) palliative care intervention for African American patients with advanced cancer, which is being formally assessed through an ongoing effectiveness-implementation trial. ... Results: Overall, there was a lack of awareness and understanding of palliative care, due primarily to limited experiences with palliative care services among study participants. Despite this lack of familiarity, participants recognized the potential benefits of palliative care for patients with advanced cancer.  

Special considerations in managing pain and psychosocial distress in patients with opioid use disorder and cancer: the role of the supportive care and psycho-oncology interdisciplinary teamAnnals of Palliative Medicine; by M Catherine Trimbur, Bridget Sumser, Chelsea Brown, Timothy Steinhoff, Khaldoun Almhanna, Dana Guyer; 7/24People with a substance use disorder (SUD) have shortened lifespans due to complications from their substance use and challenges engaging with traditional health care settings and institutions. This impact on life expectancy is especially prominent in patients with co-occurring SUDs and cancer, and often has a much worse prognosis from the cancer than a similar patient without a SUD. Palliative care teams are experts in serious illness communication and symptom management and have become increasingly embedded in the routine care of patients with cancer. We argue that the skill set of palliative care teams is uniquely suited for addressing the needs of this oft marginalized group.

Symptom burden and quality of life among patient and family caregiver dyads in advanced cancerQuality of Life Research; by Katrina R Ellis, Allison Furgal, Feyisayo Wayas, Alexis Contreras, Carly Jones, Sierra Perez, Dolapo Raji, Madeline Smith, Charlotte Vincent, Lixin Song, Laurel Northouse, Aisha T Langford; 7/24Symptom management among patients diagnosed with advanced cancer is a high priority in clinical care that often involves the support of a family caregiver. This study seeks to identify patient and caregiver symptom clusters and investigate associations between identified clusters and demographic, clinical, and psychosocial factors (cognitive appraisals and [quality of life] QOL). The most prevalent symptom for patients was energy loss/fatigue and for caregivers, mental distress. Higher symptom burden was associated with more negative appraisals of the cancer and caregiving experience, and poorer QOL (physical, social, emotional, functional, and overall QOL). Dyads whose caregivers had more chronic conditions were more likely to be in the high symptom burden subgroup.