Literature Review

He built a nursing home empire despite state investigations. Now, lawsuits are piling upCalMatters; by Jocelyn Wiener; 11/20/25California nursing homes affiliated with Shlomo Rechnitz are facing lawsuits alleging that patients were raped, ignored and unnecessarily exposed to COVID-19. His companies deny the allegations. In February 2024, a Los Angeles County jury awarded $2.34 million to an 84-year-old nursing home resident named Betsy Jentz, finding that the facility had violated her rights on 132 occasions, at times leading to serious injuries. [Three more equally offensive cases.] All of these facilities have one thing in common: state records list Shlomo Rechnitz as an owner. Court documents show Rechnitz and his companies have denied all allegations in all of the cases.

Agape Care Group acquires Community Hospice of Alabama Hospice News; by Jim Parker; 11/19/25 Agape Care Group Hospice (ACG Hospice) has acquired Community Hospice of Alabama. Financial terms of the transaction are undisclosed. Community Hospice operates three locations in the Foley, Bay Minette and Mobile communities in Alabama. Post-transaction, Agape will now provide services in 41 Alabama counties with a total of 11 locations in the state. 

United States, et al. v. UnitedHealth Group Incorporated, et al.; Response of Plaintiff United States to Public Comments on the Proposed Final Judgment Federal Register, The Daily Journal of the United States Government; A Notice by the Antitrust Division; 11/19/25 Notice is hereby given pursuant to the Antitrust Procedures and Penalties Act, 15 U.S.C. 16(b)-(h), that the Response of Plaintiff United States to Public Comments on the Proposed Final Judgment has been filed with the United States District Court for the District of Maryland in United States of America, et al. v. UnitedHealth Group Incorporated, et al., Civil Action No. 1:24-cv-03267. Copies of the Public Comments and the United States' Response are available for inspection on the Antitrust Division's website at http://www.justice.gov/​atr.

Ophthalmology considerations in end-of-life careCureus; by Mendel Shloush, Akiva Eleff, Eric Eleff; 10/25Ophthalmologic interventions can significantly impact quality of life, even in the context of end-of-life care. This paper explores the ethical and clinical considerations for ophthalmologic treatments in hospice care, with a focus on cataract surgery, age-related macular degeneration (ARMD) therapy, retinal detachment (RD) repair, glaucoma, painful blind eye (PBE) management, benign and surface ocular tumors, and corneal or anterior segment diseases. Ophthalmologic procedures should be considered viable options in end-of-life care when clinically indicated, with careful ethical review. Restoration of vision contributes meaningfully to the quality of life and deserves thoughtful inclusion in care planning.Assistant Editor's note: When a patient is terminally ill on hospice, we focus on the Big-Bad illness-the one likely to cause death. But often patients suffer from other illnesses as well. For example, when my 95-year-old mom was dying from colon cancer and on hospice, she developed a severe corneal abrasion from an inwardly turned eyelid; a comorbid condition that she had endured for many years called entropion. In this case her inwardly turned eyelashes scraped open her cornea. She was in excruciating pain from her eye. Certainly, this condition was unrelated to colon cancer. But her hospice treated her as a whole person, knowing that her eye pain was contributing to her overall suffering. To their credit, the hospice admitted her to their in-patient hospice house for GIP intervention and care. They had to sedate her deeply for several days until the abrasion began to heal. She was then able to go back home and live comfortably until her death from cancer. There is great variability in what hospices consider "related conditions" and what they believe they are responsible for in terms of payment and treatment. In this case, my mom and us family members experienced only gratitude for the holistic and expert hospice care my mom received.

Thanksgiving revisited: 2024 and 2025 I-70 West and Beyond - Travels Through Life; blog by Laurie Sunderland; Thanksgiving 2024 and 2025

Three Palmetto GBA hospice reportsPalmetto press release; 11/21/25

Sunday newsletters focus on headlines and top read stories of the last week (in order) - enjoy!   Also, remember our Job Board to find staff for the new year!

Respecting the right to refuse: Is decision-making capacity disproportionately challenged in patients declining medical care in order to treat?Journal of Neurosurgery: Case Lessons; by Jacqueline Boyle, Nicholas Comardelle, Alexis Carter, Jeffrey Klopfenstein, Todd McCall; 10/25There is a consensus that withholding aggressive medical care in medically futile situations is ethically sound, even if the patient, surrogate, or family wants everything done. The authors aim to evaluate and discuss the situations in which this request is used as justification for intervention, specifically lifesaving surgery, when a situation is defined by a futile outcome. The authors utilize the illustrative case of an older female who presented with a traumatic brain injury and Duret hemorrhage, an unfortunately common scenario faced by neurosurgeons, to discuss the complex ethical and practical implications of these situations. They seek to define futility, provide an overview of basic medical ethical principles, and evaluate both the motivation to operate and the educational gaps among patients, families, and providers. Review of the basic principles of medical ethics lends to the conclusion that the demands of a patient’s family are not adequate justification for surgical intervention in cases, such as the present one, in which a patient is unlikely to benefit.

Slow-tempo music and delirium/coma-free days among older adults undergoing mechanical ventilation-A randomized clinical trialJAMA Internal Medicine; by Babar A. Khan, Sikandar H. Khan, Anthony J. Perkins, Annie Heiderscheit, Frederick W. Unverzagt, Sophia Wang, J. Hunter Downs III, Sujuan Gao, Linda L. Chlan; 10/25Objective: To determine if a slow-tempo music (60-80 beats/min) listening intervention decreases delirium duration, delirium severity, pain, or anxiety in older adults undergoing mechanical ventilation. In this randomized clinical trial of 158 mechanically ventilated older adults, a twice-daily music intervention delivered via noise-canceling headphones and tablets for up to 7 days did not demonstrate a statistically significant decrease in delirium duration, delirium severity, pain, or anxiety.

Heart failure with reduced ejection fractionMedical Clinics of North America; by Ebrahim Barkoudah, Clyde W Yancy; 11/25Heart failure (HF) is no longer centered on the failing ventricle. Various salutary treatment discoveries now support substantially improved survival with lesser likelihood for urgent care or hospitalization. Advanced care strategies are effective, but not only includes mechanical circulatory assist and heart transplantation, but also clinical trial participation, palliative care, and hospice. At the patient level, longer healthier lives, in concert with expert management of ventricular dysfunction, becomes the contemporary expectation.

Errors in electronic health record advance care planning documentation: It's a patient safety issueJournal of Palliative Medicine; by Seth N Randa, Sarah Nouri, Anne M Walling, Kanan Patel, Mike K W Cheng, Christine S Ritchie, Brookelle Li, Gabriela Vanegas, Elle Cardoso, Rebecca L Sudore; 11/25Centralized locations in the electronic health record (EHR) improve access to advance care planning (ACP) information; however, the prevalence of documentation errors in these locations is unknown... Among 10,767 patients, 5374 (49.9%) had ACP in their EHR, and 495 (9.2%) of those had a verified error; 32.9% were Patient Safety Errors. Patients with errors were more likely to self-identify as from a minoritized population, be non-English speaking, and have a serious illness.

AI, health, and health care today and tomorrow-The JAMA Summit Report on artificial intelligenceJAMA; Derek C. Angus, Rohan Khera, Tracy Lieu, Vincent Liu, Faraz S. Ahmad, Brian Anderson, Sivasubramanium V. Bhavani, Andrew Bindman, Troyen Brennan, Leo Anthony Celi, Frederick Chen, I. Glenn Cohen, Alastair Denniston, Sanjay Desai, Peter Embí, Aldo Faisal, Kadija Ferryman, Jackie Gerhart, Marielle Gross, Tina Hernandez-Boussard, Michael Howell, Kevin Johnson, Kristine Lee, Xiaoxuan Liu, Kimberly Lomis, Alex John London, Christopher A. Longhurst, Ken Mandl, Elizabeth McGlynn, Michelle M. Mello, Fatima Munoz, Lucila Ohno-Machado, David Ouyang, Roy Perlis, Adam Phillips, David Rhew, Joseph S. Ross, Suchi Saria, Lee Schwamm, Christopher W. Seymour, Nigam H. Shah, Rashmee Shah, Karandeep Singh, Matthew Solomon, Kathryn Spates, Kayte Spector-Bagdady, Tommy Wang, Judy Wawira Gichoya, James Weinstein, Jenna Wiens, Kirsten Bibbins-Domingo, for the JAMA Summit on AI; 10/25AI will disrupt every part of health and health care delivery in the coming years. Given the many long-standing problems in health care, this disruption represents an incredible opportunity. However, the odds that this disruption will improve health for all will depend heavily on the creation of an ecosystem capable of rapid, efficient, robust, and generalizable knowledge about the consequences of these tools on health. AI is changing how and when individuals seek care and how clinicians interact with patients, establish diagnoses, and implement and monitor treatments. In contrast to drugs or more traditional medical devices, there is little consensus or structure to ensure robust, safe, transparent, and standardized evaluation, regulation, implementation, and monitoring of new AI tools and technologies.

Tellable and untellable stories in suffering and palliative careMortality; by Maxxine Rattner; 3/19The relief of patients’ suffering – both physical and non-physical – is a primary aim of palliative care, and has been described as an obligation and ethical duty for palliative care providers. This paper suggests that common approaches to relieving patients’ non-physical suffering – such as creating opportunities to make meaning, achieve personal growth, and hone one’s resiliencies – comprise the larger, more tellable part of the palliative care discourse. A more marginal, less tellable part of the discourse acknowledges that some non-physical suffering cannot necessarily be relieved.Publisher's note: Though dated, this article offers an honest perspective on the profound challenge of alleviating suffering, and the essential lesson of humble grace when relief is not possible.