Literature Review

Death with dignity: 50th anniversary of America’s first hospiceYankee Institute; by Andrew Fowler; 6/7/24 ... In the late 19th century, terminally ill patients faced undignified treatment or were even “refused admission to the hospital entirely” due to “availability of space and resources” or race and socio-economic class, according to Doctors, Death, and Denial: The Origins of Hospice Care in 20th Century America by Sarah E. Pajka. ... All of this shaped the outlook of Florence Wald — a former dean of the Yale University School of Nursing, and a Branford native. Growing up in the early 20th century, she recognized the flaws and inhumane nature of medical care toward terminal patients, telling the Associated Press (AP), on Nov. 26, 1971, that death is “a period of life that can have a lot of meaning. It can be content, full of joy, with lots of reminiscing.” But death needed to be “more human and meaningful,” as she stated in the same AP article. Throughout her career, Wald’s passion for palliative care revolutionized the medical profession, with her co-founding “The Connecticut Hospice,” the first in the United States, on June 11, 1974.  Since then, more than 5,200 hospices have been established in the country and millions have sought both in-patient and home care services. This is the story of how the first hospice was founded in Connecticut 50 years ago.  ... Editor's Note: This fascinating history of hospice's beginnnings illuminate core purposes, outcomes (are we measuring the right factors?), and current 21st century challenges. This article is published by the Yankee Institute, not Connecticut Hospice. This author frames this history as a stand against "euthanasia." Whatever one's ethical, political, or religious stand on today's MAiD issues (Medical Aid in Dying)--also referred to as physician assisted suicide--we invite you to find common ground in learning from our history and celebrating Florence Wald's co-founding of The Connecticut Hospice. For readers, what do you know about your hospice organization's history? What might you research and learn? Whom can you honor? Fifty years from now, what will be said of how your organization chose to address 2024's core hospice purposes, outcomes, and challenges?

Managing palliative care challenges for patients with complex symptoms Pharmacy Times; 6/7/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. ... Pharmacy Times: What do you wish pharmacists understood about hospice and palliative care in terms of patient care for patients with complicated symptoms? Kullgren: So, I think, number 1, pharmacists across all healthcare systems, in the hospital, at community pharmacies, long-term care, you are all going to be involved in these patients— it’s just to what degree. ... We want to do those therapies that ... are going to have the least amount of risk for our patients, or at least side effects for our patients. ...

Rural pharmacy owners say it's getting harder to stay open Times West Virginian; by Devi Shastri; 6/5/24 Rural pharmacies can be a touchstone for their communities. The staff knows everyone’s names and drugs, answers questions about residents’ mail-order prescriptions or can spot the signs of serious illness. But their business models face unrelenting pressures to the point that sometimes they have to close. An AP analysis of data from 49 states and the National Council for Prescription Drug Programs shows that several largely rural states have some of the lowest number of pharmacies per ZIP code. Editor's Note: This trend for closures in rural areas is rampant for hospitals, emergency departments, physicians, and more. Click here for a letter from NHPCO and numerous hospice providers to Congress, Jan. 5, 2024: Protect rural and frontier American's access to hospice and palliative care.

Palliative care in the intensive care unit: The standard of care AACN - American Association of Critical-Care Nurses; by Clareen Wiencek, PhD, RN, ACNP, FAAN; 6/7/24Intensive care unit–based palliative care has evolved over the past 30 years due to the efforts of clinicians, researchers, and advocates for patient-centered care. ... This article provides an overview of the current state of intensive care unit–based palliative care, examines how the barriers to such care have shifted, reviews primary and specialist palliative care, addresses the impact of COVID-19, and presents resources to help nurses and intensive care unit teams achieve optimal outcomes. [Access to the full article requires subscription or purchase of the individual article.]

Why private equity hospice investors need to re-focus on patients Hospice News; by Jim Parker; 6/7/24 As private equity investors seek out hospice and other health care transactions, they should retrain their sights on potential benefits for patients in addition to financial metrics. Driving this is a changing regulatory environment as scrutiny heats up for both hospices and the private equity firms themselves. Tightened regulation in the hospice space has led to longer, more stringent diligence processes when it comes to buying and selling provider companies. This means that potential buyers are looking hard at compliance and quality metrics before completing a deal, along with the seller’s financials.

Reply to: Frailty and ethics at the end of life: The importance of a comprehensive assessmentJournal of the American Geriatrics Society; by Colum Thomas MD, Eduardo Bruera MD, William Breitbart MD, Yesne Alici MD, Liz Blackler MBE, LCSW-R, Julia D. Kulikowski MD, Daniel P. Sulmasy MD, PhD; 6/5/24The care of older persons at the end of life often involves competing concerns and highly value-sensitive decisions. In a recent article, we proposed a set of ethical rules—the canons of therapy—to help clinicians navigate complex cases involving older adults with delirium at the end of life. The canons of therapy most pertinent to such cases are restoration, means-end proportionality, discretion, and parsimony (see Table 1 for a description). These canons provide a structured toolset aligned with practical wisdom, which can serve as an ethical heuristic for guiding therapeutic judgments. ...

Sexual function in serious illness: Areej El-Jawahri, Sharon Bober, and Don DizonGeriPal Podcast; Eric Widera, Alex Smith, Areej El-Jawahri, Sharon Bober, Don Dizon; 6/6/24As Eric notes at the end of today’s podcast, we talk about many difficult issues with our patients. How long they might have to live. Their declining cognitive abilities. What makes their lives meaningful, brings them joy, a sense of purpose. But one issue we’re not as good at discussing with our patients is sexual health. On today’s podcast Areej El-Jawahri, oncologist specializing in blood cancers at MGH, says that sexual health is one of the top if not the top issue among cancer survivors. Clearly this issue is important to patients.

Good Samaritan Hospice opens regions first freestanding hospice house CBS WDBJ TV - 7, Roanoke, VA; by Neesy Payne; 6/7/24 A grand opening celebration was held Friday, June 7, for the Sheila S. Strauss Hospice House. It’s the region’s first freestanding hospice house. It was a part of the original plans of Good Samaritan Hospice back in 1992, and 32 years later, it is now a reality. “Our primary focus will always be taking care of patients at home; but when that’s not possible, maybe someone has pain, or needs respite, or a situation just arises that they need a different level of care, then we will be able to provide that in a facility that looks and is designed to be as homelike as possible,” said President and CEO of Good Samaritan Hospice Aaron Housh. ... It includes 16 private rooms, a living room, dining room, a chapel, and a courtyard – all aimed to make residents and their families feel at home.

OKC woman charged after allegedly facilitating mother's suicide: 'Do with it what you will'The Oklahoman; by Josh Dulaney; 6/6/24A woman facing murder charges is accused of giving a firearm to her mother who then shot herself to death. In Oklahoma County District Court this week, Jaye Dee Watts, 44, was charged with first-degree murder in the commission of a crime, second-degree murder, kidnapping and aiding suicide by furnishing a weapon. Court documents reveal the shocking allegations. About 7:13 p.m. on Sept. 10 ... Oklahoma City police responded to a call about an attempted suicide involving a firearm. The caller was a hospice employee who said she had received a phone call from Watts, the victim’s daughter. According to an affidavit that was part of an arrest warrant filed by a homicide detective, Watts told the hospice employee that her mother, 72, shot herself. The hospice employee called 911 after speaking with Watts, and responding officers found Watts’ mother dead inside the home. Editor's Note: The descriptions are graphic. This is not an example of "Medical Aid in Dying" for the purpose of ending suffering, but rather an example of elder abuse paired with workplace violence.

‘The last option’: Why doctor, resident unions continue to growModern Healthcare; by Mari Devereaux; 6/6/24A wave of labor organization continues among doctors, residents and fellows as more than 3,000 have joined unions so far this year, driven by worries about burnout, administrative burden and inadequate patient care. Doctors and support staff are seeking contracts across organizations that ensure reduced workloads and more one-on-one patient care time. However, where doctors want more decision-making power, residents are pushing for better benefits and higher pay.

LeadingAge: CMS on right track with high-acuity hospice RFIHospice News; by Jim Parker; 5/31/24 The senior care advocacy group LeadingAge has praised the U.S. Centers for Medicare & Medicaid Services (CMS) inquiries into high-acuity palliative care, but expressed concern over reimbursement and staffing issues. The agency’s 2025 proposed hospice rule featured a series of requests for information (RFI) on issues like health equity, social determinants of health and future quality measures. The RFIs contain further questions about the utilization of higher-cost palliative treatments under the Medicare Hospice Benefit. The agency posed similar queries in its proposed rule for 2024. The new proposal seeks greater clarity on the financial risks and costs that providers say represent barriers to providing those services, such as palliative chemotherapy, radiation blood transfusions or dialysis, among others.

The state of the hospice nursing workforceHospice News; by Holly Vossel; 5/28/24Honing clinical scheduling and onboarding models is key to sustaining the hospice nurse workforce as demand for these clinicians rises and wages lag compared to those in other settings. Future generations of health care clinicians may be woefully unprepared to address both the quantity and and the complexity of emotional, physical and spiritual needs among a swelling aging population nearing the end of life.

How hospice valuations are shaping up in 2024Hospice News; by Jim Parker; 5/30/24When it comes to hospice acquisitions, buyers’ and sellers’ expectations on price tags are becoming more aligned. A surge of deals in 2021 and 2022 led to record-high valuations in the space with multiples reaching in excess of 30x in some instances. While many buyers were willing to pay that premium, some stepped out of the market due to the high valuations. But deal volume has largely declined in late 2023 and early 2024, and valuations are starting to come down.