Literature Review

Public healthAlzheimer's and Dementia; Stephanie Frilling; 12/24A Medicare Voluntary Advance Directive Framework (Framework) would enable the creation, storage, and sharing of advance directive documents, ensuring end-of-life care appropriately honors the individual and their care wishes, while supporting healthcare teams and family members in making care decisions for their patients and loved ones. With Medicare enrollment reaching over 65 million beneficiaries in 2023, and Alzheimer's becoming one of the most expensive conditions - CMS policy makers have a growing responsibility to improve care quality at end-of-life. 

Advance care planning among diverse U.S. older adults with varied cognition levelsAlzheimer's & Dementia; by Zahra Rahemi, Swann Arp Adams; 1/25Older adults from minority groups often experience elevated rates of chronic diseases and cognitive impairment, coupled with lower rates of engagement in advance care planning (ACP) and comfort care as they approach end of life... Our study revealed that individuals facing cognitive impairments exhibited lower rates of engagement in ACP. Notably, among the variables examined, race, ethnicity, rural residence, education, and age emerged as significant predictors of ACP in a national sample of older adults in the U.S. These findings underscore the importance of incorporating these sociodemographic factors into the design of interventional studies aimed at enhancing ACP and mitigating disparities.

Medicare to Veterans Affairs cost shifting—A challenging conundrumJAMA Health Forum; Kenneth W. Kizer, MD, MPH, DCM; Said Ibrahim, MD, MPH, MBA; 12/24In this issue, Burke et al highlight how costs previously paid by Medicare for VA-Medicare dual eligible enrollees are now being paid by the VA under the VCCP [Veterans Community Care Program]. Today, there is reason to be concerned whether VA health care will be adequately funded because of the rapidly rising VCCP expenditures (driven in part by Medicare to VA cost shifting) and the impact of caring for an additional 740,000 enrollees who have entered the system in the past 2 years. This has created a $12 billion medical care budget shortfall for FY 2024. The substantial budgetary tumult that has resulted from these dynamics is adversely impacting the front lines of care delivery at individual VA facilities, leading to delays in hiring caregivers and impeding access to VA care and timely care delivery, as well as greatly straining the traditional roles of VA staff and clinicians trying to manage the challenging cross-system referral processes. The intertwined issues of Medicare to VA cost shifting and the rising costs of the VCCP present a challenging policy and programmatic conundrum.

“I aim to fulfill my promise”: Dementia caregiving from the perspective of spouses and partnersJournal of Applied Gerontology; Haley M. Shiff, Theresa A. Allison, Madina Halim, Kenneth E. Covinsky, Alexander K. Smith, Deborah E. Barnes, Jennie M. Gubner, Kara Zamora; 1/25In the United States, spouses provide 17% of in-home care for people living with dementia. We found common features underlying the care provided by spouses/partners, including challenges and motivators guided by notions of loyalty and commitment. As cognition and function declined, care partners found the relationship increasingly difficult. They shared the feeling of being stuck as well as the loss of identity and freedom. This finding follows what Westrelin et al. (2024) describe in their study on spousal caregivers of partners living with dementia, in which spouses perceived changes not only in their partner but also in themselves and oscillated between their identity as a caregiver and as a spouse, highlighting the dynamic nature of caregiver identity construction within the context of caring for a partner living with dementia.

Transition to hospice: how it impacts the mental health of caregivers of persons with dementiaAlzheimer's & Dementia; by Oonjee Oh, Debra Parker Oliver, Karla Washington, George Demiris; 2024In this study, we aimed to examine caregivers’ mental health indicators and their correlation structure based on the timing of hospice transition... In the context of dementia care, our results highlight that caregivers who just entered hospice are undergoing a challenging transition that often finds them in a mentally vulnerable position. To develop and implement effective strategies for caregivers of persons with dementia, we need to understand the needs and vulnerabilities of caregivers during hospice transition and identify the best timing for the delivery of supportive tools.

Saturday newsletters focus on headlines and research - enjoy!

Which health facilities have been impacted by L.A.-area fires? AI may paint a clearer picture DirectRelief; by Andrew Schroeder; 1/14/25 Geospatial AI and remote sensing advance health system impact analysis shows where facilities have been damaged or destroyed -- and where medical needs may be greatest. One of the most important factors for humanitarian responders in these types of large-scale disaster situations is to understand the effects on the formal health system, upon which most people — and vulnerable communities in particular — rely upon in their neighborhoods. Evaluation of the impact of disasters ... is traditionally a relatively slow and manually arduous process, involving extensive ground truth visitation by teams of assessment professionals. Speeding up this process without losing accuracy, while potentially improving the safety and efficiency of assessment teams, is among the more important analytical efforts Direct Relief can undertake for response and recovery efforts.

DEA proposes special registrations for telehealth prescribing TechTarget - xtelligent Virtual Healthcare; by Anuja Vaidya; 1/15/25  The DEA is set to publish a proposal for a special registrations framework that would allow certain healthcare practitioners to prescribe controlled substances via telehealth without performing an in-person exam first. The unpublished proposal made available on the Federal Register details the special registrations framework, which includes three types of registrations:

Norovirus positivity rate hits 28%, double 2024's peak: 6 notes Becker's Clinical Leadership; by Alexandra Murphy; 1/15/25 A surge in norovirus infections this season has resulted in a 28% positivity rate, more than double 2024's high, alarming health officials, CBS News reported Jan. 14. The unprecedented spike is a part of a broader viral surge as the U.S. grapples with four major viruses — norovirus, respiratory syncytial virus, influenza and COVID-19. Hospitals across the country are also feeling the strain, as emergency departments struggle to accommodate the rising number of patients. ... Experts predict that the "quademic" — norovirus, syncytial virus, influenza and COVID-19 — could worsen as hospitals are already overwhelmed. With more outbreaks likely, health systems are implementing stricter protocols including visitor restrictions and increased coordination between hospitals to maintain trauma care capacity.

Diana Franchitto named Board Chair as the National Partnership for Healthcare and Hospice Innovation celebrates 10 years National Partnership for Healthcare and Hospice Innovation (NPHI), Washington, DC; 1/14/25 The National Partnership for Healthcare and Hospice Innovation (NPHI) proudly announces Diana Franchitto, President & CEO of HopeHealth, as the new Chair of its Board of Directors. A visionary leader in hospice and advanced illness care, Diana steps into this role as NPHI celebrates a decade of driving high-quality nonprofit care and innovation. “As we celebrate a decade of impact, we are thrilled to welcome Diana as the new Chair of our Board of Directors,” said Tom Koutsoumpas, CEO of NPHI. “Her deep commitment to community-based, nonprofit care and her proven leadership make her uniquely qualified to help guide NPHI into this next phase of growth and innovation. I have tremendous respect for Tom and our members’ vision for NPHI, and I’m thrilled to work closely with Tom and our entire NPHI leadership team to bring that vision to life,” said Diana. “It’s an honor to serve as Board Chair during this pivotal moment as we celebrate our first decade of impact. I look forward to collaborating with our members and Board to advance the incredible work our nonprofit hospices deliver every day. Together, we will shape the next chapter of compassionate care and champion innovative, community-driven solutions that prioritize the needs of patients and families nationwide.”

NPHI supports lawsuit to ensure proper implementation of Hospice Special Focus Program National Partnership for Healthcare and Hospice Innovation, Washington, DC; Press Release; 1/16/25Today, a lawsuit was filed by the Texas Association for Home Care & Hospice; Indiana Association for Home & Hospice Care; Association for Home & Hospice Care of North Carolina; South Carolina Home Care & Hospice Association; and Houston Hospice. The lawsuit challenges CMS’s implementation of the hospice Special Focus Program (SFP) as unlawful and arbitrary. We acknowledge that Houston Hospice, an NPHI member, is one of the plaintiffs in this legal action, and we are committed to supporting them and others impacted by the SFP or the accompanying excel files. The hospice Special Focus Program (SFP), conceived and passed on a bipartisan basis as a part of the HOSPICE Act in 2021, was designed to address poor-quality hospice providers by offering them additional support and technical assistance to ensure compliance with the Medicare Hospice Conditions of Participation. NPHI is extremely disappointed that CMS has departed from that Congressional intent, transforming the hospice SFP into a burden for many well-meaning hospices, with an algorithm for identifying providers based on inaccurate data and including elements that are not referenced in the statutory language. ... NPHI fully supports the litigation filed today, which aims to direct CMS to comply with the spirit and intent of the statute and regulations. [Click on the title's link to continue reading.]

The Alliance on CMS Hospice Special Focus Program Implementation: “Doubling down on a dangerous decision, eager to work with incoming administration to fix” National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 1/16/25 The National Alliance for Care at Home (the Alliance) issued the following statement in response to the news of hospice providers filing litigation against the Centers for Medicare & Medicaid Services (CMS) over their flawed implementation of the Hospice Special Focus Program (SFP). The Alliance and the broader hospice community, who have been engaged on this program since its inception, have repeatedly shared concerns directly with CMS staff at all levels. They warned that this approach would inflict unnecessary harm to patient care, cause confusion to families when selecting a hospice provider to care for their loved ones at the end of life, and will cause some providers to sustain irreparable damage. These concerns have been echoed by lawmakers, providers, and the leading national hospice trade organizations. “With CMS doubling down on a dangerous course of action by proceeding with the Hospice SFP in its current state—and offering no due process or administrative recourse to address or mitigate its flaws—some hospice providers will suffer irreparable harm and have no choice but to seek justice through the courts on behalf of their patients and mission,” said Dr. Steve Landers, CEO of the Alliance. [Click on the title's link to continue reading.]