Literature Review

End of life outcomes following Comfort Care Orders: A single center experience The American Journal of Hospice & Palliative Care; by Matthew Tucker, Dayna Hovern, John Liantonion, Elizabeth Collins, Adam F Binder; 5/13/24 Conclusions: The majority of patients placed on comfort care died during their hospitalization demonstrating a real need for comprehensive end of life care and immediate hospice services. For those discharged with hospice services, they spent an excessive amount of time in the hospital waiting for services to be arranged.

Musician grants dying wish to hospice patient The Platte County Citizen; by Rimsie McConiga; 5/14/24 Jazz musician Stanton Kessler was surprised when he was contacted recently by his friend, a hospice nurse, who reached out to him with an unusual request. A patient at the Kansas City hospice where she works told her his last wish would be to hear his favorite song, ‘Feels So Good’ before he died. During their conversations Kessler’s impression was that this was his friend’s first experience with a request such as this. “There was an element of urgency,” Kessler said. “She said he was near death.” ... An incredibly emotional and rewarding moment followed when Kessler began to play the patient’s beloved song. The man’s eyes remained closed, but his fingers began to move. ...Editor's Note: For research-based, hospice clinical stories, and rich music metaphors for ways use music with the dying and bereaved, examine the book, Music of the Soul, Chapter 7 "The Final Cadence," in Routledge's international Series in Death, Dying, and Bereavement (series edited Robert A. Neimeyer), authored by Joy S. Berger, DMA, FT, BCC, MT-BC (editor for this newsletter).

When families fight over a relative with dementia, it’s time to call in the mediator The New York Times; by Paula Span; 5/13/24 Trained negotiators can help families struggling with vexing elder-care issues.  The four adult children were in agreement. Their father, William Curry, a retired electrical engineer and business executive, was sinking deeper into dementia. ... [But their mother] remained determined to continue caring for her 81-year-old husband at home, despite the increasing toll on her own health. ... As the weeks passed, “we were really at an impasse,” [a daughter] said. “Do you override your mother?” ...  [Increasingly,] families seek elder mediation privately, before disputes land in court and imperil or destroy family relationships. [Continue reading for descriptions of how mediation differs from arbitration, from family therapy, and for cautions about this being "a fairly new field with no nationwide certification or licensing requirements."]Editor's Notes: Executive leaders, what community education and resources are you providing for Advance Directives? What family systems education and and problem-solving are you providing for your interdisciplinary team members and grief counselors? Family conflicts are inherent--in some form or fashion--with almost anyone needing dementia care, especially when paired with palliative or hospice care. (If in doubt, ask your seasoned, front-line professionals.)

NAHC advocacy scores wins in CongressNAHC Newsroom; Press Release; 5/10/24Tireless advocacy by the National Association for Home Care & Hospice (NAHC) and our partners at the National Hospice and Palliative Care Organization, has resulted in the approval of the Preserving Telehealth, Hospital, and Ambulance Access Act (H.R. 8261) through the Ways & Means Committee of the U.S. House of Representatives. While the committee advanced the legislation, it will still need to be passed by the full House of Representatives and the Senate as well. This first step was crucial to get the bill on the pathway to its ultimate enactment into law. This legislation provides:

Maryland becomes sixth state to require salary, wage disclosures in job listings McKnights Senior Living; by Kathleen Steele Gaivin; 5/10/24 Maryland soon will join five other states and the Washington, DC, in requiring employers to disclose salary or wage ranges upfront in job listings. Maryland’s requirement goes into effect Oct. 1. The states of California, Colorado, Hawaii, New York and Washington have similar laws in place, with the requirement expected to go into effect in the nation’s capital, on June 30. ... After a first violation, the employer will receive a warning. Fines for noncompliance range then will range from $300 for the second violation to $600 for subsequent violations. 

CMS extends Medicaid waivers to 2025 Becker's Payer Issues; by Rylee Wilson; 5/13/24 CMS will extend flexibilities designed to help states keep more eligible individuals enrolled in Medicaid through June 2025. The waivers, previously set to expire at the end of 2024, will be extended for six more months, Daniel Tsai, deputy CMS administrator and director of the Center for Medicaid and CHIP services, wrote in a May 9 memo to states. Nearly all states were expected to complete the unwinding process by June 2024, Mr. Tsai wrote, but because several states took extension waivers from CMS, several states will continue renewals past June. 

California to redirect more than $7B in healthcare funding Becker's Hospital CFO Report; by Mackenzie Bean; 5/13/24 California is seeking to divert more than $7 billion in funding from the healthcare sector to address a major funding deficit, according to a revised budget proposal released May 10. Gov. Gavin Newsom has proposed reallocating $6.7 billion from Medi-Cal provider rate increases planned for Jan. 1, 2025, to balance the state budget. This funding was generated by the managed care organization tax created last year. ... The proposed budget would also cut funding for healthcare workforce initiatives by $854.6 million through 2028. Funding for public health and various behavioral health programs would also be reduced. 

Hospital CEOs ask patients to receive care at home Becker's Hospital Review; by Madeline Ashley; 5/14/24 Hospital executives are making the push to move more care, specifically recovery rooms and exams, out of the hospital and into patient homes, to potentially save money and improve finances as the country continues to move out of the pandemic, Politico reported May 11. And Congress is supporting these efforts by introducing legislation that would expand at-home care and to allow Medicare to continue funding telehealth. Here are five findings from the report: ... [Click on the title's link to read more.]

St Oswald's Hospice launches 'emotional' portraits exhibition highlighting end-of-life care Chronicle Live, United Kingdom; by Sam Volpe; 5/11/24 An emotional new exhibition has opened highlighting "the bond that doesn't die" when a loved one dies and promoting the care offered by St Oswald's Hospice. Entitled Portraits with Purpose: Continuing Bonds, and created by Fenham artist Leanne Pearce, the exhibition features twelve portraits of people who have received or are receiving palliative and end-of-life care at St Oswald's. Leanne has created the artwork working closely with the families - who have experienced care and support from the charity at the most difficult of times. 

Nurse practitioners improve skilled nursing's dementia care outcomes, but regulatory barriers remain: studyMcKnights Long-Term Care News; by Josh Henreckson; 5/13/24[Nurse pracitioners'] NPs’ involvement can significantly improve end-of-life care outcomes for residents with Alzheimer’s disease and related dementias (ADRD), according to the results of a new study in JAMA Health Forum. ... Those benefits, however, were shrunk by state regulations on the scope of care NPs are allowed to provide. ...  Elizabeth White, PhD, assistant professor of health services, policy and practice at Brown University [describes,] “For example, when a state restricts NPs from signing Do Not Resuscitate orders, that can serve as a barrier to advance care planning and could contribute to unnecessary hospitalizations at the end of life.” Editor's Note: We posted this JAMA Health Forum article on : Nurse Practitioner care, scope of practice, and end-of-life outcomes for nursing home residents with dementia. 

Failure is not the opposite of success: it’s part of success. — Arianna Huffington, businesswoman

Beyond medicine: 'Being Mortal' challenges healthcare's approach to death and dying SwiftTelecast; by Shawn Butlere; 5/11/24 This video from the “Frontline” series, titled “Being Mortal,” follows Dr. Atul Gawande as he explores the complex relationships between doctors, patients, and end-of-life decisions. Based on his best-selling book “Being Mortal,” Gawande discusses how medical training often falls short in preparing doctors for the realities of death and dying. The documentary highlights personal stories, including Gawande’s own experiences with his father’s illness and death, to illustrate the challenges in balancing hope with realistic outcomes and the importance of quality life in the face of terminal illness. 

A Philadelphia pharmacy’s closure after 26 years highlights the industry’s growing challenges Times Daily; by Lizzy McClellan Ravitch, The Philadelphia Inquirerer; 5/11/24Last Monday, Friendly Pharmacy filled 318 prescriptions. For about 100 of them, insurance companies paid the pharmacy less than $3. In 22 instances that day, the reimbursement was less than the cost of the medication. ... [Managing pharmacist Brad] Tabaac plans to close his doors on May 31 after 26 years in business. ... Independent pharmacies like Friendly, as well as some chains, have been pinched by pricing and fees set by pharmacy benefit managers — the companies that handle prescription drug plans for health insurance. The three biggest pharmacy benefit managers are CVS Health, Optum Rx and Express Scripts. They control nearly 90% of the market, according to the National Community Pharmacists Association (NCPA), and some of their parent companies also own pharmacies.