Literature Review

Revenue pressures driving home care consolidation, private equity’s growing influence, provider group saysMcKnight's Home Care; by Adam Healy; 6/11/24Pressures such as insufficient government reimbursement and rising Medicare Advantage penetration are contributing to consolidation in home care and hospice, LeadingAge told regulators last week in response to a February request for information surrounding healthcare market competition. “Sustainable fee-for-service rates that cover the continually rising costs of delivering care are of critical importance,” LeadingAge said. “Outside revenue pressures such as lower reimbursement rates from managed care plans, reduced units of service through accountable and managed care organizations, and an increasing need to be an organization of a certain size in order to contract with managed care organizations and accountable care organizations are also factors that drive consideration of consolidation options.” One particular concern, LeadingAge noted, is the growing investment in healthcare by private equity firms. Private equity firms have driven a significant share of home care and hospice consolidation in recent years. PE firms had a hand in 35 home health deals, 15 personal care deals and 13 hospice deals last year, according to a recent report. And studies have shown that patients receiving care from PE-owned providers may experience worse health outcomes than patients at nonprofit agencies.

Spousal caregivers need emotional support before losses, not just after, study findsMcKnight's Long-Term Care News; by Donna Shryer; 6/9/24A recent study suggests that healthcare professionals and policymakers should expand their focus on supporting the emotional well-being of individuals whose spouses have dementia, especially in the years leading up to their partners’ deaths. The clinical investigation, published in the Journal of the American Geriatrics Society, indicates that these caregivers experience heightened levels of psychological distress compared to those whose partners have normal cognitive function. ... After the partner’s death, the levels of loneliness and depression were similar across all groups, regardless of the deceased partner’s cognitive status. This suggests that the period before the loss is particularly challenging for those caring for a spouse with dementia. Furthermore, about two-thirds (64%) of these spouses reported lower life satisfaction compared to nearly three-quarters (74%) of those with cognitively healthy partners. However, the study found no significant difference in social isolation levels among the groups.

June is Adult Protection Awareness MonthKREX Grand Junction (CO); by Jessica Livingstone; 6/8/24June is Adult Protection Awareness Month, and Mesa County kicked this month off by tying purple ribbons around their campus to show their support for the victims. WesternSlopeNow talked to HopeWest about the resources they have to protect the community. If you’d like to know more information about HopeWest’s resources, you can call or click here.Publisher's Note: How is your hospice participating in Adult Protection Awareness Month?

MedPAC releases June 2024 report on Medicare and the health care delivery systemMedPac - Medicare Payment Advisory Commision; Press Release; 6/13/24The Medicare Payment Advisory Commission (MedPAC) released its June 2024 Report [on June 13, 2024] to the Congress: Medicare and the Health Care Delivery System. Each June, as part of its mandate from the Congress, MedPAC reports on improvements to Medicare payment systems, issues affecting the Medicare program, and changes to health care delivery and the market for health care services. This year’s report covers the following topics:

Hospital nurse staffing variation and Covid-19 deaths: A cross-sectional studyInternational Journal of Nursing Studies; by Karen B. Lasater, Matthew D. McHugh, Linda H. Aiken; 6/24During the Covid-19 pandemic, Covid-19 mortality varied depending on the hospital where patients were admitted, but it is unknown what aspects of hospitals were important for mitigating preventable deaths. Patients with Covid-19 admitted to hospitals with adequate numbers of RNs caring for patients, a workforce rich in BSN-qualified RNs, and high-quality nurse work environments (both prior to and during the Covid-19 pandemic) were more likely to survive the hospitalization. Bolstering these hospital nursing resources during ordinary times is necessary to ensure better patient outcomes and emergency-preparedness of hospitals for future public health emergencies.Publisher's Note: Also see related KFF Health News article Chronically Understaffed US Hospitals Saw More Covid Deaths, Data Indicate.

Adapting the Serious Illness Conversation Guide for dementia careAmerican Journal of Hospice and Palliative Care; by Charlotte E Berry, Sophie H Montgomery, Robert Santulli, Amelia Cullinan; 8/24Advance care planning (ACP), a critical component of quality dementia care, is underutilized due to lack of clinician comfort and the challenging nature of ACP in this context. The Serious Illness Conversation Guide (SICG) is a well-validated clinician-facing tool, developed with patient and clinician input, to facilitate ACP. The aim of this project was to adapt the SICG for dementia for the first time to promote high-quality ACP.

Parental history of memory impairment and β-amyloid in cognitively unimpaired older adults JAMA Neurology; by Mabel Seto, PhD; Timothy J. Hohman, PhD; Elizabeth C. Mormino, PhD; Kathryn V. Papp, PhD; Rebecca E. Amariglio, PhD; Dorene M. Rentz, PsyD; Keith A. Johnson, MD; Aaron P. Schultz, PhD; Reisa A. Sperling, MD; Rachel F. Buckley, PhD; Hyun-Sik Yang, MD; 6/17/24 Objective: To characterize maternal vs paternal history of memory impairment in terms of brain Aβ-positron emission tomography (Aβ-PET) and baseline cognition among a large sample of cognitively unimpaired older adults. Conclusions and Relevance  In this study, maternal history (at any age) and paternal history of early-onset memory impairment were associated with Aβ burden among asymptomatic older individuals. Sex-specific parental history may help inform clinicians on likelihood of Aβ burden in offspring and help identify high-risk individuals at the earliest stages of disease for prevention.Editor's Note: We posted a descriptive, less data-oriented article that was about this research on 6/21/24, "Alzheimer’s history on maternal side linked to higher disease risk, study finds"

Understanding adult hospices caring for children in California, 2018-2021Heather A. Davis, PhD1, Meaghann S. Weaver, PhD, MD, MPH2,3,Christy Torkildson, PhD, RN, PHN, FPCN, HEC-C4,5, andLisa C. Lindley, PhD, RN, FPCN, FAAN6AbstractIn areas where there are absences of pediatric hospice care, adult hospices are often asked to provide hospice care for children.Little is known about these adult hospices. The purpose of our study was to describe the characteristics of adult hospices inCalifornia that provided care to children from 2018 to 2021. Using public data from the California Home Health Agencies andHospice Annual Utilization Report, we conducted a longitudinal, retrospective descriptive study to examine the effects ofhospice characteristics on adult hospices which provide care to children. Market, mission, operational, and financial characteristicswere measured via the California utilization data using descriptive statistics. Service area was measured via latitudeand longitude public data. Hospice location maps were generated for year 2018 and year 2021. The 148 hospices in the studyhad distinct organizational profiles, mainly small, with broad service coverage areas, in rural and urban communities withpredominantly nurses visiting children. There was a significant decline (32%) in availability of adult hospices caring for childrenbetween 2018 and 2021, particularly in northern California. Hospice economics, lack of familiarity with Medicaid, and staffcomfortability with caring for children in hospice, were not driving this decline. Our study provides critical insight into thecharacteristics of adult hospices in California providing care for children and has important policy implications.

Narrating final memories from spousal loss: The role of place and quality of deathAmerican Journal of Hospice and Palliative Medicine; by Emily L Mroz, Susan Bluck; 8/24Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. ... Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.Editor's Note: Per Yale press release: Emily Mroz, PhD, postdoctoral fellow in the Yale Department of Internal Medicine’s Section of Geriatrics, recently received the Association for Death Education and Counseling (ADEC) Edie Stark-Shirley Scott Early Achievement Award. The honor is presented annually to a woman in the initial years of a career in thanatology—the study of death, dying, and bereavement—who has distinguished herself through activity in scholarship, service, research, clinical practice, or social action.

If not us, who? If not now, when? ~John F. Kennedy

US Medicare Hospice and Palliative Medicine Physician Workforce and Service Delivery in 2008-2020Journal of Pain and Symptom Management; by Xin Hu, Changchuan Jiang, Qinjin Fan, Kewei Sylvia Shi, Ravi B Parikh, Arif H Kamal, Roger T Anderson, K Robin Yabroff, Xuesong Han; 6/24Despite growth in Medicare HPM physician workforce, access is disproportionately concentrated in metropolitan and inpatient settings. This may limit receipt of early outpatient specialized palliative care, especially in nonmetropolitan areas.

Other Business Headlines of Interest, updated 6/20/24 per nasdaq.com