Literature Review

The 'great disruption' coming for Medicare Advantage Becker's Payer Issues; by Jakob Emerson; 9/9/24 Come mid-October, the Medicare Advantage program will enter its annual enrollment period, marked by significant changes for older adults. Among these changes are increased government scrutiny, tighter CMS regulations, reduced base payments, and rising healthcare costs. ... "Taken together, some are calling these cuts 'the great disruption,'" wrote Sachin Jain, MD, CEO of SCAN Group, a nonprofit MA carrier with more than 285,000 members, in a LinkedIn post on Sept. 4. Dr. Jain outlined five key observations about the evolving landscape:

Gilchrist and Hospice of Washington County join forces in landmark affiliation agreementGilchrist [MD] press release; 9/9/24Hospice of Washington County and Gilchrist, Maryland’s leading provider of geriatric, palliative, and hospice care, have announced an affiliation agreement. This partnership will unite two of Maryland’s oldest and most experienced nonprofit organizations, together with nearly 70 years of service to their communities.

Bittersweet bouquet: Hospice worker transforms her grief into a garden of memories ABC 13, Grand Rapids, MI; by Matt Gard; 9/5/24For the most part, Kaitlyn Dawson’s desk at the Emmanuel Hospice office is exactly what you’d expect it to be. On her left, she has office supplies, ... but it’s what’s on the wall over her left shoulder that really gives this workspace character. Inside three separate picture frames are hundreds of flowers. Kaitlyn was an art major at Grand Valley State University before she switched to social work, and she still has a passion for creativity. Every one of those flowers – whether red, purple or orange - was her creation. ... “These flowers represent patients that I have been able to be a part of their journey at end of life,” said Kaitlyn, who has worked in hospice for about four years. “I had one particular case that was really difficult, and I remember leaving that visit and thinking ‘I'm going to start doing this process in honor of her.’ And I went to the store and I bought pencils and a notebook and decided I was going to do flowers. It was easy. It was simple. It was something I could sit down and do in the evening, and if I lost a couple of people that day, I could draw a couple of flowers.” Before Kaitlyn knew it, she had a "bittersweet bouquet."

Leading the Way: Gilchrist and Franklin Hospice forces in landmark integration Franklin Hospice, Chambersburg, PA; by Karen M. Giffin; 9/9/24 Franklin Hospice and Gilchrist ... have announced an affiliation agreement. This partnership will unite two of Maryland’s oldest and most experienced nonprofit organizations, together with nearly 70 years of service to their communities. As the healthcare landscape continues to transform nationwide, this type of affiliation of two synergistic nonprofit organizations with similar missions, visions, and values will position both organizations for continued growth, innovation and financial strength. ... This strategic affiliation will strengthen their ability to offer compassionate care to more patients and families throughout Central and Southern Maryland, as well as Washington and Frederick Counties and South-Central Pennsylvania. Both organizations will retain their name and branding while offering a unified approach to care. 

NAHC and NHPCO unveil name, logo, and website for newly formed organizationPress Release; 9/5/24The National Alliance for Care at Home will combine the strengths of the two largest national organizations representing healthcare providers delivering care primarily in homes. The Alliance will provide unparalleled resources and representation to support the care-at-home community.

Allowing patients to die: Louise Aronson and Bill AndereckGeriPal podcast; by Alex Smith, Eric Widera, Louise Aronson, Bill Andereck; 9/5/24In today’s podcast we set the stage with the story of Dax Cowart, who in 1973 was a 25 year old man horribly burned in a freak accident. Two thirds of his body was burned, most of his fingers were amputated, and he lost vision in both eyes. During his 14 month recovery Dax repeatedly demanded that he be allowed to die. The requests were ignored. After, he said he was both glad to be alive, and that the doctors should have respected his wish to be allowed to die. But that was 1973, you might say. We don’t have such issues today, do we? Louise Aronson’s recent perspective about her mother in the NEJM, titled, “Beyond Code Status” suggests no, we still struggle with this issue. And Bill Andereck is still haunted by the decision he made to have the police break down the door to rescue his patient who attempted suicide in the 1980s, as detailed in this essay in the Cambridge Quarterly of HealthCare Ethics.

All of us, at some time or other, need help. Whether we’re giving or receiving help, each one of us has something valuable to bring to this world. That’s one of the things that connects us as neighbors—in our own way, each one of us is a giver and a receiver. ~Mr. Rogers

Adoption of artificial intelligence-enabled robots in long-term care homes by health care providers: Scoping reviewJournal of Medical Internet Research; Karen Lok Yi Wong, Lillian Hung, Joey Wong, Juyoung Park, Hadil Alfares, Yong Zhao, Abdolhossein Mousavinejad, Albin Soni, Hui Zhao; 8/24Long-term care (LTC) homes face the challenges of increasing care needs of residents and a shortage of health care providers. Literature suggests that artificial intelligence (AI)-enabled robots may solve such challenges and support person-centered care. We identified three barriers to AI-enabled robot adoption: (1) perceived technical complexity and limitation; (2) negative impact, doubted usefulness, and ethical concerns; and (3) resource limitations. Yet, our findings show that health care providers might not use robots because of different considerations. The implication is that the voices of health care providers need to be included in using robots.

Understanding the home hospice experience of Puerto Rican caregiversAnnals of Palliative Medicine; Taeyoung Park, Veerawat Phongtankuel, Marcela D Blinka, Milagros Silva, Dulce M Cruz-Oliver; 8/24Hospice use among Hispanic Medicare beneficiaries has declined in the last few years, and Hispanic caregivers have reported insufficient support around the emotional and spiritual aspects of care. Caregivers found managing patients' loss of appetite, pain, anxiety, and confusion to be challenging. They identified family-centered values and religious support as culturally important, which manifested as the need for frequent communication from hospice providers and increased support and education at the end-of-life. Culturally tailored interventions that focus on managing symptoms, tailoring care to support family-centered values, integrating religious officials representative of the patient's beliefs into the hospice team, and communicating effectively with providers may reduce the burden experienced by PR caregivers in home hospice and improve outcomes for patients and caregivers.

Current understanding of cardiovascular autonomic dysfunction in multiple sclerosisHeliyon; Insha Zahoor, Guodong Pan, Mirela Cerghet, Tamer Elbayoumi, Yang Mao-Draayer, Shailendra Giri, Suresh Selvaraj Palaniyandi; 8/24Autoimmune diseases, including multiple sclerosis (MS), are proven to increase the likelihood of developing cardiovascular disease (CVD) due to a robust systemic immune response and inflammation. CVD in MS patients can affect an already damaged brain, thus worsening the disease course by causing brain atrophy and white matter disease. Treating vascular risk factors is recommended to improve the management of this disease. Additionally, clinicians should monitor for cardiovascular complications while prescribing medications to MS patients, as some MS drugs cause severe CVD.

[Norway] Quality of life and relationships in caregivers of people with dementia. A gender perspectiveAmerican Journal of Alzheimer's Disease and Other Dementias; Heidi Bjørge, Kari Kvaal, Ingun Ulstein; Jan-Dec 2024Home-dwelling people with dementia rely on their family members to be able to stay at home. This affects the family caregivers' quality of life (QoL). Both male and female caregivers' depression influenced their QoL. For females, their own social distress influenced their QoL, and for males, their experience of their care receivers' overemotional attitude influenced their QoL. Significant gender-specific differences were found, indicating that gender must be considered when approving caregivers' needs and planning interventions for caregivers.

CMS teases new cybersecurity policies for third-party vendors Modern Healthcare; by Bridget Early; 9/13/24 The Centers for Medicare and Medicaid Services is planning oversight of third-party healthcare vendors in the wake of the Change Healthcare cyberattack, said Jonathan Blum, the agency's principal deputy administrator. Blum, who also serves as chief operating officer for CMS, said at Modern Healthcare's Leadership Symposium Thursday that the agency is working to determine what levers it can pull to ensure severe disruptions in care like those linked to the cyberattack on the UnitedHealth Group subsidiary aren’t repeated. ... Almost 133 million individuals were affected by healthcare data breaches last year, more than double the number of those affected in 2022 and a number equivalent to about 40% of the U.S. population.

Accuracy of the “surprise question” in predicting long-term mortality among older patients admitted to the Emergency Department: Comparison between emergency physicians and nurses in a multicenter longitudinal studyPalliative Medicine Reports; by Alexandra Coulon, Delphine Bourmorck, Françoise Steenebruggen, Laurent Knoops, Isabelle De Brauwer, on behalf of the COPE Project; 8/24The “surprise question” (SQ) (“Would you be surprised if this patient died in the next 12 months?”) is the most frequently used screening tool in emergency departments (EDs) to identify patients with poor prognosis and potential unmet palliative needs... The SQ is a simple tool to identify older ED patients at high mortality risk. Concordant responses from [emergency physicians and nurses] are more predictive than either alone.