Literature Review

Hospitals Think Some Dead Patients Are AliveBloombergDecember 7, 2023Neil Wenger, a professor of medicine at UCLA, was researching different ways of encouraging patients to make end-of-life care plans when he discovered something troubling—hundreds of patients who were seriously ill, according to the health system’s records, were actually dead. This is a well-known but little-studied phenomenon, according to Wenger—until now. Wenger and his colleagues wrote up their findings in a short paper that was published Monday in JAMA Internal Medicine. They identified 676 patients from UCLA’s health system that were recorded as alive, but were actually dead, according to state data. At face value, it sounds absurd. But there are many reasons why it might happen, Wenger says. While patients who die in the hospital are automatically recorded as deceased in that system’s database, patients who die at home are not. Same goes for patients who die at another health system with a different electronic records database. “The health system continues to act as if they’re alive,” Wenger says. “If we don’t know they’re dead, we can’t do the right thing.” ... “We think this is a really important finding that needs to be corrected,” Wenger says.

A President’s GriefPodcastAll There Is with Anderson Cooper/CNN.comDecember 6, 2023[For his podcast All There Is, about living with grief, CNN’s Anderson Cooper interviewed President Biden, who, Cooper writes, has “been more open than any sitting US president about the deaths he’s experienced and the grief he still lives with [having lost his wife and infant daughter when he was 30 and his older son Beau to brain cancer following Beau’s deployment to Iraq].” When Cooper showed up at the White House for the interview, he asked if he could trade the traditional interview setup—two chairs far apart—for a more intimate setting across a table; Biden agreed. The result, Cooper says, was the most “personal interview about grief and loss” that a US president has ever taken part in.]

Work for a cause, not for applause.Live life to express, not to impress.-Unknown

Mass. lawmakers approve measure allowing more home health care workers to unionizeWBUR-FM (Boston, MA)December 7, 2023Thousands of home health care workers in Massachusetts are newly eligible to organize and join a union under legislation passed by the state legislature this week. Union officials estimate the change will allow some 4,000 home health care workers to unionize. About 58,000 personal care attendants paid by MassHealth are already unionized and represented by SEIU 1199. 

Dameron Hospital in Stockton hit by cyberattackKCRA-TV (Sacramento, CA)December 5, 2023Stockton, CA—Dameron Hospital in Stockton said it is investigating a cyberattack that has forced some patients to reschedule their procedures. The hospital said in a statement Tuesday that “patient care operations are functioning normally,” which includes its emergency department. The hospital described the issue as a “data security incident that has impacted certain systems on our network.” It did not say when the attack happened or describe which systems may have been compromised.

America Is Having Yet Another Drug Shortage. Here’s Why It Keeps Happening.By Emily Tucker, PhDNew York TimesDecember 6, 2023The American Society of Health-System Pharmacists found this summer that nearly all of the members it surveyed were experiencing drug shortages, which generally affect half a million Americans. Cancer patients have scrambled as supplies of chemotherapy drugs dwindle. ... Over half of the shortages documented this summer by health consulting firm IQVIA had persisted for more than two years. But even though drug shortages affect millions of Americans, policymakers and industry leaders have provided little to no long-term relief for people in need. ... The people who are most affected by supply chain vulnerabilities—patients—are also those with least say in the choice to buy from reliable manufacturers. ... Legislative action is the only real way to ensure the availability of essential medications. After 20 years of drug shortages, it seems clear that markets alone are not the solution. And there are a few specific ways Congress should address drug shortages. The first is to ensure better quality drug manufacturing. Modernizing manufacturing facilities would make them more reliable and prevent shortages. The second is to improve the adaptability of drug manufacturing itself. Manufacturers should be able to switch quickly to alternative facilities or to increase production when demand unexpectedly increases. The last is to maintain buffer inventory of essential medications within our health care system.

Shifting focus to MA will alter ‘life as we know it’ for home care providers, experts sayMcKnight’s Home Care DailyDecember 7, 2023Medicare Advantage is disrupting the traditional home care landscape, experts from the Research Institute for Home Care said in a webinar hosted Wednesday afternoon by the National Association for Home Care & Hospice. As MA continues to dominate Medicare and cover those beneficiaries receiving home health, certain trends—such as access issues or shifting utilization rates for services within traditional Medicare—have become more pronounced. “Medicare Advantage is growing, and that’s going to result in a decreased volume in home health claims among traditional Medicare beneficiaries,” Elizabeth Hamlett, senior research associate for evaluation and health economics at KNG Health, said during the webinar about the recently released 2023 RIHC [Research Industry for Home Care] Chartbook. Home health users in general also may become more reflective of the characteristics of MA beneficiaries—which essentially means sicker and poorer, she said. ... However, MA and fee-for-service beneficiaries showed greater variation in their reported access to home health services. “What we’re seeing here is potentially an access problem for Medicare Advantage users,” Hamlett said.

OIG’s Audit of Nursing Home Workers in Louisiana Finds Flaws in Background Check ProcessSkilled Nursing NewsDecember 6, 2023A federally commissioned report released Wednesday found that nursing homes in Louisiana failed to complete background checks on a portion of their non-licensed employees. In conducting the audit to examine whether Louisiana nursing homes complied with federal requirements for backgrounds checks, the Office of Inspector General chose a sample of 9 Louisiana nursing homes out of a total of 276 licensed facilities in the state, basing its sample size on a variety of risk factors and on the need to select nursing homes in urban and rural settings, the agency said. ... The OIG report states. “Although Federal requirements do not specify the methods or types of information that should be considered for a background check to be regarded as having been satisfactorily completed, we identified potential limitations in the nursing homes’ background check searches and adjudication methods for 49 of the 209 non-licensed employees we reviewed.” In response to OIG’s findings and recommendations, Louisiana has agreed to update its standard survey process to ensure routine monitoring of nursing homes’ compliance with background check requirements by reviewing a sample of 5% of current non-licensed staff and by directing nursing homes to conduct self-audits of current personnel files. ... Among the findings, some disturbing practices emerged. Of the 9 nursing homes closely investigated, six nursing homes, and some of the staffing companies with which they contracted, had employee background check searches conducted that did not include a statewide search of State police records.

Tower Health laid off 30 people on TuesdayPhiladelphia InquirerDecember 6, 2023Tower Health laid off 30 people on Tuesday, citing efforts to streamline operations at the nonprofit health system based in Berks County. Not included in that total were an unspecified number of people in Tower’s information technology department, whose jobs were moved to an outside vendor. “Although Tower Health’s financial position has improved, we still face challenges and are working hard collectively as an organization to improve performance,” Tower said in a statement. 

Here’s why you can’t die peacefully in Oklahoma.By Abby RemmingThe OklahomanDecember 6, 2023... Having Medicare or a Medicare Advantage plan would cover hospice, but many people have private insurance from work or state Medicaid plans. Private insurance and Medicaid Advantage plans at times can have a hospice benefit but limit which companies can be used. Applying for Medicare will ensure you are covered for hospice. ... I currently work as a hospital social worker and assist many people who need hospice. Many times, I have had to share with patients and their families that, while they may be ready to peacefully pass away, hospice coverage is not included in the patient’s current insurance plan. Providing end-of-life care is extremely difficult without the added burden of worrying whether insurance will cover the benefit. Those without the benefit and who need the service are then reliant upon the generosity of the companies to absorb the cost. If the Medicaid Advantage plan is picked, a person would need to decide if they wanted the benefit to either cover nursing home care or in-home hospice care. A Medicaid Advantage plan might not cover hospice even when the policyholder believes they have the benefit. 

In key home care victory, House passes Elizabeth Dole Home Care ActMcKnight’s Home Care DailyDecember 7, 2023Providers, industry organizations and advocates applauded the House’s passage of the Elizabeth Dole Home Care Act on Tuesday evening. “It’s a good recognition, especially on the House’s part, that reinforces home care as an industry,” Jason Lee, chief executive officer of the Home Care Association of America, said in an interview on Wednesday with McKnight’s Home Care Daily Pulse. “They see the value in the services, and that is so critically important.” The Elizabeth Dole Home Care Act would introduce various provisions to make home care more accessible for veterans. Among the key ones: The cost of providing veterans noninstitutional alternatives to nursing home services, such as home care, may not exceed 100% of the cost that would have been incurred if they had received Department of Veterans Affairs nursing home care. ... Of course, the Elizabeth Dole Home Care Act still has to win Senate approval.

Rosalynn Carter advocated for caregivers before the term was widely used. I’m so grateful.By Mitul DesaiUSA TodayDecember 6, 2023It started with a story. When asked about her lifelong commitment to improving mental health services and support for caregivers, former first lady Rosalynn Carter would share her experience on the campaign trail: Exhausted caregivers urgently reaching to grab her hand. Families pleading for resources. Americans bravely sharing their stories of hurdles and heartache. From these anecdotes emerge a legacy marked by courage and compassion. A woman ahead of her time, fighting for caregivers before the term was even widely used. ... I fiscovered the Rosalynn Carter Institute for Caregivers as a vibrant resource in an otherwise desolate landscape of caregiver support. I participated in a series of workshops that RCI facilitated aimed at helping streamline the diverse experiences of caregiving into nine distinct stages. Our hope is that this new approach—which moves beyond diagnosis-driven categorization to focus instead on the types of support needed at each phase of the experience—will inform policy and practice for health practitioners, employers, policymakers and organizations serving caregiver needs.

More people with dementia opting to age in place over senior livingMcKnight’s Senior LivingDecember 7, 2023People living with dementia are more likely to choose aging in place over an assisted living or a continuing care retirement community, according to a new study. A research letter in the Journal of the American Geriatrics Society reported that over the last two decades, a variety of factors have shifted where people with dementia live, including family caregiver availability, declining marriage and birth rates, alternative residential care arrangements, Medicaid expansion of home- and community-based services and the long-term care workforce crisis. Researchers said their study showed that the COVID-19 pandemic noticeably altered living arrangements for individuals living with dementia, increasing the number of those opting to age in place. ... What concerned researchers was increasing functional impairment and levels of unmet needs among those living alone or in a residential care setting, including assisted living and CCRCs, “given the limited regulatory oversight and lack of uniformity in services available in these settings.”