Literature Review

Home care industry slams finalized 80-20 Rule, warns agency closures are coming Home Health Care News; by Andrew Donlan; 4/22/24 The “Ensuring Access to Medicaid Services” rule has been finalized. Most importantly, the bemoaned “80-20” provision has gone through as proposed, meaning providers will eventually be forced to direct 80% of reimbursement for home- and community-based services (HCBS) to caregiver wages. ... Organizations like the National Association for Home Care & Hospice (NAHC) and LeadingAge immediately condemned the rule being finalized on Monday. ...

Hospice boss warns of funding challenges BBC News; Josh Sandiford; 4/28/24[United Kingdom] A West Midlands hospice boss has warned it faces a "huge challenge" under the current funding model. Acorns Children's Hospice, which is based in Birmingham, told the BBC the situation was not sustainable despite demand for its services growing. It came after Hospice UK said there was a £77m funding deficit at centres across the UK. Editor's Note: We highlighted this recurring theme from the United Kingdom in posts on 4/16/24 and 4/17/24 in our "International" section. Pairing this critical, ongoing financial crisis with our article on 4/19/24, "Will Assisted Dying in Europe Impact Living With Dignity?", how might these potential losses of effective hospice care impact patients' desires for assisted dying? What similar trends are we seeing in the United States?

States lack resources to support new Medicaid waiver programs, association asserts McKnights Home Care; by Adam Healy; 4/22/24Medicaid 1115 waivers, which are commonly used to improve or expand home- and community-based services, face serious challenges as understaffed state programs are increasingly incapable of moving proposals through the administrative “pipeline,” the National Association of Medicaid Directors said in a recent letter. “The tough reality is that the Center for Medicaid and CHIP Services, which has taken many steps to streamline its administrative processes, simply does not have the staff resources to move forward all of the waivers in its pipeline,” Kate McEvoy, executive director of NAMD, wrote in the letter. 

Remote access technologies expose home care firms to cybersecurity vulnerabilities, experts sayMcKnights Home Care; by Adam Healy; 4/18/24 Some of the most commonly used technologies in home care are also among the easiest for criminals to exploit. ... Remote access systems include any technology that allows users to connect to and access a computer, server or network remotely. Within home care, this could be tools such as remote patient monitoring devices, secure messaging apps, telehealth platforms, cloud-based applications or systems that allow users to remotely access patient data, according to the Department of Health and Human Services. And while these technologies bring efficiency, they can also expose providers and their patients to risk.

Extra: CMS publishes rule outlining final staffing requirements McKnights Long-Term Care News; by Kimberly Marselas; 4/22/24 The Centers for Medicare & Medicaid Services said it would exempt nursing homes from having registered nurse coverage for up to 8 out of 24 hours a day “under certain circumstances,” unveiling a critical new detail in the second part of today’s staffing rule rollout. A director of nursing also can count toward the rule’s 24/7 RN requirement, CMS said, noting a change that providers will likely appreciate given their persistent challenges hiring RNs across the country. “The RN onsite 24 hours a day, seven days a week requirement ensures that there is an RN available to help mitigate, and ultimately reduce, the likelihood of preventable safety events, particularly during evenings, nights, weekends, and holidays,” CMS said. ...

Examining how improper payments cost taxpayers billions and weaken Medicare and Medicaid HHS-OIG; by Christi A. Grimm, Inspector General, Office of Inspector General, U.S. Department of Health and Human Services; 4/16/24 HHS Inspector General Christi A. Grimm Testifies Before the U.S. House Committee on Energy and Commerce, Subcommittee on Oversight and Investigations on April 16, 2024. IG Grimm briefs members on HHS-OIG's work to address improper payments in Medicare and Medicaid managed care programs. Click here to watch the testimony.

Time to rethink assisted dying?Bioethics; by Udo Schuklenk; 5/24... But who should be tasked with the provision of such services [assisted suicide and / or voluntary euthanasia], given that it would no longer be the case that only people defined as patients would be eligible for an assisted death. Healthcare professionals might object to providing such services to people who aren't patients. Different societies could decide to introduce permissive assisted dying regimes tasking different professionals with the provision of such services. If doctors are the profession tasked with the provision of such services in a particular jurisdiction, they ought to provide it to those eligible in that society. However, it is worth considering whether a newly created assisted dying profession, that is equally tightly regulated, may be a preferable way forward.

Textures of Black sound and affect: Life and death in New OrleansAmerican Anthropologist; by Matt Sakakeeny; 6/24In a traditional New Orleans jazz funeral, the characteristic shift from mourning to joy is propelled by brass band musicians weaving melodies and rhythms together. This article is about how these thickly layered textures of sound elicit shared sentiments of lament and of joy.

Environmental comfort in promoting sleep in critically ill patients: A scoping review[Portugal] Dimensions of Critical Care Nursing; by Derek Braga Moura, Débora de Fátima Sousa Andrade, Carla Rodrigues Silva, Igor Emanuel Soares-Pinto; 5/24It is important to understand the concept of comfort as a whole to build an assistance intervention plan that meets the person's needs. Therefore, it is necessary to monitor and assess the person's sleep by considering the surrounding environment, to provide a comfortable environment that is quiet and provides privacy, especially in contexts of difficult management of environmental factors in the approach to the person in critical condition.Publisher's note: 

Making end-of-life health disparities in the U.S. visible through family bereavement narrativesPEC Innovation; by Cassidy Taladay-Carter; 4/24End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care. ... Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond.

End-of-life and palliative care for lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity older adultsClinics in Geriatric Medicine; by Evie Kalmar MD, MS, Jeffrey Mariano MD; 5/24Lesbian, gay, bisexual, transgender, queer or questioning, or another diverse gender identity (LGBTQ+) people are more likely to have alternative family structures. It is important to engage in advance care planning to understand their values, clarify surrogate decision makers, and contribute to goal-concordant care at the end of life. Clinicians can follow recommendations in this article to ensure they are providing LGBTQ-inclusive palliative and hospice care.

Hospice satisfaction among patients, family, and caregivers: A systematic review of the literatureAmerican Journal of Hospice and Palliative Medicine; Timothy Hoff, PhD, Kathryn Trovato, MPH, Aliya Kitsakos, BA; 6/24Thirty-eight studies were included in the review. Key findings were: (a) higher levels of hospice care satisfaction among patients, families, and other caregivers; and (b) correlates of hospice care satisfaction falling into the categories of communication, comfort, and support. The published literature had fewer findings related to demographic correlates of satisfaction such as age or race/ethnicity and was lacking in comparative research examining satisfaction across different types of hospice care settings.

Quality in Motion: Acting on the CMS National Quality Strategy CMS - Centers for Medicare & Medicaid Services; 4/22/24In 2022, the Centers for Medicare & Medicaid Services (CMS) launched the CMS National Quality Strategy (NQS), a plan aimed at improving the quality and safety of health care for everyone, with a special focus on people from underserved and under-resourced communities. ... The CMS National Quality Strategy has four priority areas, each with two goals. This action plan provides details on how CMS is putting these eight goals into action.