Literature Review

CMS issues memo with contingency plans for state survey & certification activities in the event of federal government shutdown CMS - Center for Clinical Standards and Quality; by CMS Directors, Quality, Safety & Oversight Group (QSOG) and Survey & Operations Group (SOG); 10/1/25 On October 1, 2025, CMS issued QSO-26-01-ALL identifying State Survey and Certification functions that (a) are not affected by a Federal shutdown, (b) excepted functions that are to be continued in the event of a shutdown (also referred to as “essential functions”), and (c) other activities that are directly affected and therefore should not be operational during a Federal shutdown. CMS also clarified that Hospice Surveys funded through the Consolidated Appropriations Act (CAA) of 2021are considered mandatory and are not impacted by the Federal Government shutdown. Work funded under these sources should continue.

[Portugal] End-of-life care in the prison environment (supplement #22) ehospice, republished from by Portual Plus; 9/25/25 “Inmates who are dependent on assistance have a significant need for help from fellow prisoners,” stated Manuel Almeida dos Santos, secretary-general of the Obra Vicentina de Auxílio aos Reclusos (OVAR) [i.e., St. Vincent de Paul Work to Aid Prisoners], citing the lack of nursing aides and other professionals within prisons. “The shortage of human resources is not limited to prison guards. The deficiencies in prisons are even greater in other areas,” he argued. This concern was echoed by Vítor Ilharco, president of the Associação Portuguesa de Apoio ao Recluso [i.e., Portuguese Association for Prisoner Support], who mentioned cases of sick or elderly inmates who are bedridden, with their families paying “fixed amounts” to other inmates for assistance. Editor's Note: Log in to your newsletter account, type "prison" in the "Search" field, and compare this with many articles we've published on this topic; notably, "IL law calls for annual report on prison hospice, palliative care" and "Death and redemption in an American prison."

Government shutdown impact on telehealth for hospice and palliative care providers Lund Person & Associates; by Judi Lund Person; 10/1/25 At 12:01 am on October 1, 2025, the US federal government shut down without an agreement on a continuing resolution (CR) to fund the government. The shutdown affects many functions of the federal government. This memo will focus on the telehealth provisions for hospice and palliative care. ...[Examine this definitive resource, addessing the following topics:]

One year after Hurricane Helene: Lessons in resilience, recovery, and renewal Hospice & Palliative Care Today; Joy Berger and Cordt Kassner with Vern Grindstaff, Millicent Burke-Sinclair, and Chris Comeaux; 9/26/25 At this time last year, Hospice & Palliative Care Today brought you a series of articles reporting on the devastating impact of Hurricane Helene across the Southeast, focusing on hospices in the North Carolina mountains. We remain deeply grateful for the many ways you—our readers and colleagues—rallied in support of those hospice organizations and their communities during their time of urgent need. This Saturday, September 27, 2025, marks the one-year anniversary of that epic disaster. To reflect on what has been learned and how recovery has unfolded, Vern Grindstaff (CEO of Compassionate Care WNC, Burnsville, NC), Millicent Burke-Sinclair (President and CEO of Four Seasons, Flat Rock, NC), and Chris Comeaux (President and CEO of Teleios Collaborative Network, Flat Rock, NC) gathered in conversation with Cordt Kassner (publisher) and Joy Berger (editor-in-chief). The insights that follow honor the hospice employees who persevered to provide urgent patient care. We celebrate their spirit of compassionate community and courageous problem-solving from the onset one year ago through ongoing recovery.

Start where you are. Use what you have. Do what you can. ~Arthur Ashe 

Adult Protective Services work with clients at the end of life: Challenges and support needsJournal of Elder Abuse and Neglect; by Wei-Lin Xue, Joy Swanson Ernst, Pi Ju Liu; 9/25Adult Protective Services (APS) professionals frequently interact with clients who are seriously ill or dying as they investigate cases of elder abuse and self-neglect. This study explored the unique challenges and support needs of APS workers in these end-of-life contexts. Thematic analysis identified two overarching domains: (1) challenges – including family conflict, limited caregiver preparedness, client self-determination, challenges to service access, and emotional strain on professionals; and (2) support needed – such as improved interagency collaboration, peer and organizational support. Participants emphasized the emotional toll of witnessing client decline and death, and highlighted gaps in training, coordination, and workplace support. Findings highlight the need for targeted policy and practice reforms to better equip APS professionals addressing elder abuse and self-neglect at the end of life.

Medicaid coverage policy variations for chronic pain and opioid use disorder treatmentJAMA Network Open; by Meredith C. B. Adams, Seth M. Eller, Cara McDonnell, Sarjona Sritharan, Rishika Chikoti, Amaar Alwani, Elaine L. Hill, Robert W. Hurley, ; 8/25Co-occurring chronic pain and opioid use disorder (OUD) are associated with a high disease burden for the patient, requiring comprehensive treatment approaches, yet Medicaid benefit structures for evidence-based therapies vary substantially across states. Our systematic economic evaluation reveals both promising developments and persistent challenges in Medicaid coverage for treatment of co-occurring OUD and chronic pain. Universal coverage of fundamental medications and basic interventional procedures provides a foundation for care, but varying implementation approaches create a complex landscape requiring further investigation.

Emergency Department care coordination program for assisted living residents with dementia-A qualitative studyJAMA Network Open; Grace F. Wittenberg, Peter T. Serina, Nichole E. Stetten, Ann Reddy, Ellen McCreedy; 8/25Care transitions to the emergency department (ED) from assisted living centers (ALCs) for residents may include incomplete or inaccurate information during transfer. These transitions can be especially difficult for vulnerable populations, including persons living with dementia (PLWD). In this qualitative study of a care coordination intervention, CCMs [complex care managers] advocated for their patients remotely by filling information gaps, particularly for PLWD and patients in hospice, and perceived that the intervention was associated with improved patient care. CCMs also identified key areas for improvement, such as to increase ED staff awareness of the program and to expand program hours.

[UK] From living well to dying well with dementia: The significance of an expanded understanding of loss for end-of-life carePalliative Care and Social Practice; by Joseph M Sawyer, Paul Higgs; 9/25As rates of dementia increase, the need for care is clear. Understanding what this looks like and how people might orientate the narratives and practices of care against a universally relatable version of success is less clear cut yet seems crucial if we are to progress towards an ideal of care that allows for a 'good' or 'dignified' death with palliative care. With this as a central focus, the paper examines the orientating principles that govern the current approach to dementia care. We map the evolution in academic theory from deficit-based models of care that identify impairments as a means to building resources to counter them, towards capacity-oriented approaches that focus on accommodating the new experiences that dementia brings. Where conventionally dementia has been viewed through the reductionist lens of being either a biological or social challenge to which there should be a matching solution, it is perhaps more useful to look at it from the inside out, to learn the lessons that dementia and its associated vulnerabilities may hold for humanity.

Communication surrounding treatment preferences for older adults with dementia during emergency medical services responseJournal of the American Geriatrics Society; by Lauren R. Pollack, Danae G. Dotolo, Anna L. Condella, Whitney A. Kiker, Jamie T. Nomitch, Elizabeth Dzeng, Nicholas J. Johnson, Thomas D. Rea, May J. Reed, Michael R. Sayre, Erin K. Kross; 9/25Emergency Medical Services (EMS) providers, capable of rapidly delivering life-prolonging interventions, are often first to respond to acute health concerns for older adults in the United States. Prior work has shown a preference among many people with dementia for comfort-focused care near end-of-life. EMS providers treating critically ill older adults with dementia face challenges that may hinder their ability to elicit treatment preferences, in particular when responding to calls from professional caregivers. Direct communication with surrogate decision-makers may facilitate goal-concordant care.Assistant Editor's note: Being an RN for over 40 years, I have seen many changes in health care, especially in what is expected now of patients/families. I remember the day when nurses were not permitted to share with the patient his/her own BP reading; instead, we were to tell patients to "ask the doctor". Back then the doctor controlled almost all aspects of the patient's care, as well as the sharing of information with the patient about his/her own medical condition. I am glad those days are gone. Now, patients are expected to engage in ongoing discussions regarding advance care planning, execute written advance directives, and are expected to share their care preferences with health providers and loved ones and/or caregivers. It would be an ideal world where health care providers were continuously aware of evolving patient preferences and could always deliver goal concordant care. I believe we need to keep working toward this goal, but I also understand that this expectation can add burden to patients who are already extremely burdened with the many difficult aspects of serious illness. I believe that, as health care providers, we need to appreciate that some people simply cannot or will not share their preferences; it is simply too scary, too foreign, too difficult to do so.

Pennant Group completes strategic acquisition of operations Investors Hangout; by Ryan Hughes; 10/2/25 ... Pennant Group is set to integrate operational assets worth approximately $146.5 million, encompassing various home health, hospice, and personal care services primarily situated in the Southeast. This acquisition includes 54 locations across multiple states, primarily focusing on the healthcare needs of communities in the region. ... An important aspect to highlight is that about two-thirds of the total revenue is associated with home health services, while the remaining third is linked to hospice care.