Literature Review

Bridge the gap: Addressing rural end-of-life care disparities and access to hospice services Journal of Pain and Symptom Management; by Asif Anwar, Muhammad Kashif Amin, Sherezaad Anwar, Moazzam Shahzad; 7/11/24 online ahead of print Rural hospices face many obstacles in delivering palliative and end-of-life care in the United States. We aimed to identify these barriers and their potential solutions. ...  We propose several potential solutions to overcome these hurdles and improve access. ... Advanced practice providers should be considered to serve as physician heads in rural hospices, which would expand resources in areas with physician shortages. A single per diem payment model should be implemented for rural hospices, regardless of the level of care provided, to help offset the higher cost of care. he Critical Access Hospital program and offering cost-based reimbursement for swing-bed stays could improve access to post-acute care, including hospice services. Telehealth can improve the timeliness of care and reduce travel costs for patients and providers.  [Continue reading for more solutions.]

Ethical challenges in the treatment of patients with severe anorexia nervosa Psychiatry Online; by Patricia Westmoreland, MD; Jole Yager, MD; Jonathan Treem, MD; and Philip S. Mehler, MD; 7/15/24 Ethical principles assist us in determining the best course of action with regard to patients with [anorexia nervosa] AN. The vast majority of patients with AN should be offered high-quality, restorative-informed care. But for a minority of patients (e.g., those with SE-AN) other treatment options need to be considered. Clinicians are obliged to realistically assess each patient’s potential for recovery or ability to engage in harm reduction and palliative care approaches, and be cognizant of the wishes of the patient, family, and treatment team. In addition, the burden on caregivers and stewardship in the expenditure of health care resources should also be considered when deciding whether involuntary treatment, harm reduction, palliative care, or end-of-life care be recommended for a particular patient.

Utility of do-not-resuscitate orders for critically ill infants in the NICU Pediatric Research - the American Pediatric Society, the European Society for Paediatric Research, and the Society for Pediatric Research; by Shannon Y. Adams, Katherine Redford, Randall Li, Ana Malfa, Richard Tucker and Beatrice E. Lechner; 7/5/24 To better understand the value of DNR orders for critically ill infants in the NICU, a prospective mixed-methods approach was utilized including chart review of infants who died in a regional NICU over a twenty-six-month period and surveys of their neonatologists, neonatal fellows, and nurses. Impact:

It starts with a story: A four-step narrative-based framework for serious illness conversations Journal of Palliative Medicine; by Natalie Lanocha, Sara Taub, Jason N Webb, Mary Wood, Tyler Tate; 7/5/24 online ahead of print An original and innovative identity-centered conceptual framework for serious illness conversations was developed. The framework consists of a four-step, reproducible approach: (1) attend to patient narrative identity, (2) identify values, (3) cocreate goals, and (4) actively promote choices. In short: attend, identify, create, and promote (AICP). ... By using this conceptual framework and four-step approach, clinicians can accomplish goal-concordant serious illness care and build rich clinical relationships that foster trust and goodwill. 

The difference between a successful person and others is not lack of strength, not a lack of knowledge, but rather a lack of will. ~Vince Lombardi

Waverly nursing home put on probation, nurse suspended in connection to death of a resident, documents show ABC KETV-7, Omaha, NE; by Jake Anderson and Aaron Hegarty; 7/17/24 A nursing facility has been placed on probation by the Nebraska Department of Health and Human Services in connection to the death of a resident. Constance Glantz, 74, was mistakenly declared dead at The Mulberry at Waverly, a nursing home, in June. Glantz was then taken to a funeral home in Lincoln, which realized that she was still breathing. The 74-year-old, who was in hospice care, was declared dead hours later at a Lincoln hospital. A public records request by KETV Investigates shows that a state investigation into the facility in Waverly found the registered nurse on duty failed to take Glantz's blood pressure after it was believed she had died. That nurse was suspended, according to the state investigation. Documents show that the state also found a second case where a patient was not evaluated correctly. ... [Nebraska AARP Director Todd Stubbendieck] points to Medicare.gov's tool, which rates nursing homes, as a resource. He also points to a similar tool from ProPublica.

Why CommonSpirit Health is investing in the home Becker's Helath IT; by Giles Bruce; 7/18/24 Chicago-based CommonSpirit Health has grown into the country’s largest Catholic provider of care at home. ... Becker's recently sat down with Trisha Crissman, interim executive director of CommonSpirit Health at Home, to discuss the metamorphosis of at-home care. ... [In 2010] ... we established hospice as another service line for the organization. ... And that brings us to where we find ourselves today — as the largest Catholic care-at-home provider in the country, with 84 locations and soon to be about 15 states, serving about 15,000 patients daily, with skilled home healthcare, hospice, palliative care, home infusion. We have many solution models, including "hospital at home," SNF [skilled nursing facility] at home, and ED [emergency department] diversion solutions.

Mount Pleasant Correctional Facility makes donations to regional hospice and animal shelter Fort Madison Daily Democrat; by Brad Vidmar; 7/18/24 Staff at the Mount Pleasant Correctional Facility (MPCF) presented two big checks to two worthy causes on Monday. During a presentation at the prison, a check for $5,000 was presented to All God’s Creatures and a check for $10,000 was presented to Southeast Iowa Regional Hospice. ... The $10,000 provided by MPCF for their donation to Southeast Iowa Regional Hospice came from a car washing and detailing program that incarcerated individuals at the prison perform for MPCF staff. Stroud explained that the prison still has a hospice room but said its lack of use in recent years persuaded staff to look consider donating money elsewhere.

Risky business: Home sweet home or nursing home? American Nurse - Perspectives; by Christopher Hirschler, PhD, MCHES; 7/18/24 In 2018, “Nursing homes: Good intentions, sad realities” chronicled Rita Hirschler’s experience in a nursing home after decades of being a private care nurse. In response to the ideas espoused in the article, namely that a person has a right to live and die in their home and risks are unavoidable whether one lives at home or in a nursing home, a commentator asked, “What is the solution?” ... According to the Center for Medicare Advocacy and Lu and Lu, ownership and sponsorship type have been shown to significantly impact the quality of care in nursing homes, with for-profits generally having lower staffing levels and poorer patient outcomes. The Centers for Disease Control and Prevention, Meyer, and KFF Health News say for-profit nursing homes now account for approximately 72% of the more than 15,000 U.S. nursing homes, and they provide varying levels of care to 1.3 million residents. 

How to advocate for an older loved one in the ER or hospital US News & World Report - Health; by Christine Comizio; 7/17/24 Picture your 80-year-old father in the intensive care unit needing dialysis or your 76-year-old mother with severe dementia facing emergency surgery. These scenarios are becoming increasingly common as 1 in 6 adults in the U.S. are now over 65, a number steadily rising with the aging baby boomer generation. And as our population ages, the likelihood of an older family member becoming hospitalized grows. Many of us will inevitably confront the challenges of hospitalization – oftentimes due to a medical emergency when we least expect it. The critical question is: Are you prepared? ... Editor's Note: For hospice and palliative care professionals who have not yet experienced the serious illness needs of an "older loved one in the ER or hospital," know that personally dealing with needs requires different roles, skill sets, presence, actions, and advocacy than those in your professional role. Be true to your relationship and role with the person needing care. This practical article can be a great resource for your organization's employees, volunteers, and community education. 

Senior living and care on track to set mergers and acquisitions record McKnights Senior Living; by Kathleen Steele Gaivin; 7/18/24 Mergers and acquisitions involving senior living communities and skilled nursing facilities set a new quarterly record of 183 publicly announced transactions in the second quarter, and when annualized, the sector is on track to set a new yearly record as well. That’s according to data released this week by LevinPro LTC. The number of mergers and transactions in the second quarter was 21% higher than the 151 transactions recorded in the first quarter and 49% higher than the 123 deals in the second quarter of 2023. 

Hospice gets huge response as it finds Tad a new home Beatrice Daily Sun; by Christina Lyons; 7/17/24 When the Cottonwood Hospice team wrote a Facebook post about a patient’s dog that needed to be rehomed, they were not expecting the overwhelming response they received. Owner Anni Paulmeyer said Katie Genrich, a hospice nurse, had come to her with concern for a patient who needed to rehome a dog because of declining health. ... Genrich said her patient had found the white Swiss shepherd when he was a year to 2 years of age. He named him Tad because he always said “the dog was a tad much when he was younger.” The patient cared for Tad for about nine years, but due to declining health and the need to move to a nursing facility, wanted to rehome Tad. Paulmeyer wrote a Facebook post and asked people to share the post. “A day or so later the post had been shared 2,800 times. ..."