Literature Review



Perspectives on the challenges of planning for and accessing long-term dementia care services through Medicaid and Medicaid Waivers

05/24/25 at 03:10 AM

Perspectives on the challenges of planning for and accessing long-term dementia care services through Medicaid and Medicaid WaiversJournal of Applied Gerontology; Justine Scattarelli, Kelly Moeller, Dana Urbanski, Marguerite DeLiema; 4/25 Formal long-term services and supports (LTSS) are essential to support older Americans with chronic conditions, such as Alzheimer’s disease and related dementias (ADRD). However, few older adults have saved enough to pay for LTSS, and navigating Medicaid eligibility criteria presents significant challenges. We conducted semi-structured, in-depth interviews with aging services professionals and caregivers of older adults with ADRD to assess challenges to planning for and accessing LTSS coverage through Medicaid and Medicaid waivers. Using concept mapping, three main themes were identified: (1) Proactive planning, (2) decision points, and (3) the application process. Participants described misconceptions about LTSS coverage, challenges with enrollment, and lack of information about eligibility affecting the LTSS planning trajectory. Results demonstrate a critical need for resources that help caregivers estimate costs and guide them through the eligibility determination, application, and spend down processes for Medicaid programs.

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The 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancer

05/24/25 at 03:05 AM

The 2016 CDC Opioid Guideline and analgesic prescribing patterns in older adults with cancerJAMA Network Open; Rebecca Rodin, MD, MSc; Lihua Li, PhD; Karen McKendrick, MPH; Krista Harrison, PhD; Lauren J. Hunt, PhD, RN; Ulrike Muench, PhD, RN; Cardinale B. Smith, MD, PhD; Melissa D. Aldridge, PhD, MPH, MBA; R. Sean Morrison, MD; 5/25In 2016, the Centers for Disease Control and Prevention (CDC) published guidelines cautioning against prescribing opioids for chronic noncancer pain. In this cohort study of older adults with cancer, the 2016 CDC guideline was associated with a decline in first-line opioids while less-safe tramadol and less-effective gabapentinoid prescribing continued to rise. Further revision of the recent 2022 CDC guideline and oncology pain management guidelines may be needed to help address these potentially inappropriate analgesic shifts.

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Saturday newsletters

05/24/25 at 03:00 AM

Saturday newsletters focus on headlines and research - enjoy!

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Exploring the impact of acquisition on quality of care among US home health agencies

05/24/25 at 03:00 AM

Exploring the impact of acquisition on quality of care among US home health agenciesHealth Services Management Research; by Debra Winberg, Jillian Torres; 5/25Throughout the United States and Europe, the home health care industry is rapidly consolidating, with merger and acquisition (M&A) activity on the rise. The consolidation of the industry raises questions about the impact that diminished competition may have on the quality of care being delivered. This study examines the impact of home health agency acquisition on quality of care among a sample of 10,184 home health agencies across the United States. Utilizing publicly available data from the Outcome and Assessment Information Set (OASIS) and the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) from 2018 to 2022, this study investigates changes in clinical outcomes, organizational process measures, and patient experience. The findings suggest there is a modest 1.07 percentage point improvement in process measures post-acquisition, but no significant changes in outcome or patient experience measures among the 169 agencies that were acquired during the study period. These findings suggest that, while integration has the potential to modestly improve home health process efficiency, there is very little benefit to patients.

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[Taiwan] Spiritual well-being of terminally ill patients and next-of-kin caregivers in hospice care: A quantitative and qualitative approach

05/24/25 at 03:00 AM

[Taiwan] Spiritual well-being of terminally ill patients and next-of-kin caregivers in hospice care: A quantitative and qualitative approachPalliative and Supportive Care; Er-Jung Hsueh, Shu-Chun Tsai, Jun-Hung Lai, Chi-Yu Lu, Tsai-Wei Huang, Made Satya Nugraha Gautama; 4/25Terminal cancer patients often endure significant distress, impacting their quality of life. Spiritual well-being provides peace and meaning during this challenging period. This mixed-methods study included 30 terminally ill patients and 17 next-of-kin caregivers in hospice care. Spiritual well-being was assessed using the Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12), and symptom distress with the Edmonton Symptom Assessment Scale. Patients showed a significant improvement in spiritual well-being over time, ... [and] symptoms such as shortness of breath ... , drowsiness ... , and anxiety ... were negatively associated with spiritual well-being. Caregiver spiritual well-being positively influenced patient scores, especially with female caregivers ... Qualitative findings supported these results, revealing themes of spiritual adjustment, the impact of physical symptoms on spiritual well-being, and the crucial role of caregivers in providing emotional and spiritual support.

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Successful strategies for operationalizing goals-of-care documentation

05/24/25 at 02:00 AM

Successful strategies for operationalizing goals-of-care documentationNEJM Catalyst: Innovations in Care Delivery; by Matthew J. Gonzales, Nusha Safabakhsh, Suzanne Engelder, Deborah Unger, Ira Byock; 5/25Goals-of-care (GOC) conversations are critically important to ensure that clinical teams and health systems know what matters to their patients, enabling treatment plans to be aligned with patients’ goals. However, because many conversations are ad hoc and clinician dependent, patients with serious medical conditions often do not have GOC conversations documented in their health record... [In 2024], 2024, 8,533 out of 10,063 (84.8%) of patients who were in an ICU for 5 or more days had a documented GOC conversation in the electronic health record at some point between hospital admission and prior to the fifth ICU day. This compares with a preintervention rate of just 555 out of 8,143 (6.8%) of patients who were in an ICU for 5 or more days having a documented GOC conversation [in 2016]. Essential strategies included centering efforts within the organization’s mission and vision, partnering with clinical leaders to set strong quality standards and corresponding metrics, easing documentation within the electronic health record, and designing and implementing effective communication skills–building workshops.

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Memorial Day 2025: Resources, events, and ways to honor our fallen heroes

05/23/25 at 03:00 AM

Memorial Day 2025: Resources, events, and ways to honor our fallen heroes Hope for the Warriors; retrieved from the internet 5/22/25 Each year, as the last Monday of May approaches, we are reminded that Memorial Day is more than just the unofficial start of summer. It is a sacred time to honor the brave men and women who made the ultimate sacrifice for our freedoms. Ways to Honor and Remember:

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Music as medicine: Jenny Chen, Tyler Jorgensen, & Theresa Allison

05/23/25 at 03:00 AM

Music as medicine: Jenny Chen, Tyler Jorgensen, & Theresa AllisonGeriPal podcast; by Eric Widera, Alex Smith; 5/22/25As you know, dear listeners, I love music. We start each podcast with a song in part to shift the frame, taking people out of their academic selves and into a more informal conversation. Well, today’s guests love music at least as much if not more than me, and they each make a strong case for music as medicine. Jenny Chen is a palliative care fellow at Yale who regularly sings for her seriously ill patients... Tyler Jorgensen not only plays music for his patients, starting out with just pulling up a tune on his iPhone, he and others at UT Austin and Dell med now wheel a record player into patients rooms and play vinyl, taking patients back to the sounds and routines – think taking the record out of the sleeve, placing the needle in the groove – of younger days... And Theresa Allison is a geriatrician and ethnomusicologist who studies the role of music for people with dementia.

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Proposed California budget calls for prior authorization for hospice in Medicaid

05/23/25 at 03:00 AM

Proposed California budget calls for prior authorization for hospice in Medicaid Hospice News; by Jim Parker; 5/22/25 The proposed California budget would require prior authorizations for hospice care within the state’s Medicaid program. Currently, Medicaid managed care plans who provide coverage through the state’s Medicaid system, Medi-Cal, may not perform prior authorizations for hospice. California’s Department of Health Care Services (DHCS) indicated in a 2025-2026 budget revision that this could save $25 million over the next two years and more than $50 million in the long term. If enacted, this would make California the first state in the nation to implement such a rule, according to the California Hospice & Palliative Care Association (CHAPCA). The association contends that the anticipated $25 million in cost savings is “speculative and fails to account for the downstream costs and systemic burdens this proposal would create,” according to a position paper shared with Hospice News. ... CHAPCA recommended to the state government three alternative approaches: ...

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New law will fast-track completion of hospice death certificates

05/23/25 at 03:00 AM

New law will fast-track completion of hospice death certificatesFlorida Politics; by Drew Wilson; 5/21/25 Grieving families will spend less time waiting on paperwork come July 1.Gov. Ron DeSantis has signed legislation that would take some stress off palliative care physicians who guide patients through their final hours, as well as the grieving families they leave behind. Sponsored by Republican Rep. Dana Trabulsy, HB 647 would allow Advanced Practice Registered Nurses (APRNs) to complete and file death certificates for hospice care patients. Valid death certificates must record both time of death and cause of death before the deceased’s remains can be turned over to a funeral director. Under current law, a doctor must determine the cause of death and sign the certificate. That will remain the case after Trabulsy’s bill goes into effect July 1 for non-hospice deaths.

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‘Wake-up call’: Aggressive cancer care common at end of life, supportive care lacking

05/23/25 at 03:00 AM

‘Wake-up call’: Aggressive cancer care common at end of life, supportive care lackingHealio; by Josh Friedman; 5/22/25Nearly half of people with advanced cancer receive aggressive care at the end of life, a rate little changed from a decade ago. At the same time, use of palliative or supportive care remains rare, despite increasing evidence that they are a key component of high-quality, patient-centered care. ... Meanwhile, two other studies showed oncologists’ individual practice patterns and institutional resources can play a significant role in determining which patients receive systemic therapy or early palliative care at the end of life.

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Today's Encouragement: True heroism is ...

05/23/25 at 03:00 AM

True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever the cost, but the urge to serve others at whatever cost. ~ Arthur Ashe

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Health systems need radical transformation. Are C-suites ready?

05/23/25 at 03:00 AM

Health systems need radical transformation. Are C-suites ready? Becker's Hospital Review; by Laura Dyrda; 5/21/25Health systems faced with ever-thinning margins and uncertain financial future may be tempted to double-down on cost cutting as an immediate option relief. But for most, that’s not the best option. ... “Amid unprecedented volatility, resource constraints, and technological disruption, how can healthcare executives rapidly adapt and transform their organizations to sustainably deliver high-value care, optimize operational efficiency, and preserve workforce resilience and empathy?” posed Craig Albanese, MD, CEO of Duke University Health System in Durham, N.C. The question is urgent and complex. Hospital leaders are searching for connecting points with old friends, rivals, community organizations and other stakeholders to problem-solve together. They’re also pursuing larger strategic changes instead of small fixes to truly build sustainable organizations for the future. ...

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Case of brain-dead pregnant woman kept on life support in Georgia raises tricky questions

05/23/25 at 03:00 AM

Case of brain-dead pregnant woman kept on life support in Georgia raises tricky questions AP - The Associate Press, Atlanta, GA; by Kate Brumback, Sudhin Thanawala and Geoff Mulvihill; 5/16/25 The case of a pregnant woman in Georgia who was declared brain dead and has been kept on life support for three months has given rise to complicated questions about abortion law and whether a fetus is a person. Adriana Smith, a 30-year-old nurse and mother, was about two months pregnant on Feb. 19 when she was declared brain dead, according to an online fundraising page started by her mother. Doctors said Georgia's strict anti-abortion law requires that she remain on life support until the fetus has developed enough to be delivered, her mother wrote.

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First FDA-cleared Alzheimer's blood test could make diagnoses faster, more accurate

05/23/25 at 03:00 AM

First FDA-cleared Alzheimer's blood test could make diagnoses faster, more accurate NPR; by Jon Hamilton; 5/21/25 A new blood test that detects a hallmark of Alzheimer's is poised to change the way doctors diagnose and treat the disease. The test, the first of its kind to be cleared by the Food and Drug Administration, is for people 55 and older who already have memory problems or other signs and symptoms of Alzheimer's. The results show whether the brain of a person with cognitive symptoms also has amyloid plaques, clumps of toxic proteins that build up in the spaces between brain cells. The presence of plaques in a person with cognitive symptoms usually confirms an Alzheimer's diagnosis.Editor's note: Game-changer!

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Inaugural walk raises awareness for pancreatic cancer

05/23/25 at 03:00 AM

Inaugural walk raises awareness for pancreatic cancer Columbus Jewish News, Beachwood, OH; by Becky Raspe; 5/21/25 On April 30, Wexner Heritage Village held its inaugural Zusman Hospice & Pancreatic Cancer Walkathon fundraiser. Held at Bexley’s Schneider Park, the event was held in memory of Rob Cohen, brother of Wexner Heritage Village and Zusman Hospice’s volunteer coordinator Judi Koval. Cohen died three years ago from pancreatic cancer ... under the care of Wexner Heritage Village’s Zusman Hospice “at the end of his days.” Organizing the walk to honor her brother, the event date also would’ve been her brother’s birthday, she said. 

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Hospice Care Compare released 5/21/25

05/23/25 at 03:00 AM

Hospice Care Compare released 5/21/25

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Social Media Watch 5/23/25

05/23/25 at 03:00 AM

Social Media Watch 5/23/25

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Securing philanthropic support for palliative care

05/23/25 at 03:00 AM

Securing philanthropic support for palliative care Hospice News; by Markisan Naso; 5/21/25 Fundraising has long been a necessity for many nonprofit organizations to provide palliative care programs. Currently, Medicare payment for palliative care only covers physician or licensed independent practitioner services and does not support the full range of interdisciplinary care, involving nurses, chaplains, aides and social workers. This shortage of funds has made community-based palliative care into a loss leader for many organizations. Palliative care is among the most “underfunded” services in the health care continuum, according to Deborah Johnson, chief philanthropy officer at Empath Health, a large non-profit post-acute care organization in Florida.

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‘Marathon’ effort to refine end-of-life wound coding runs on

05/23/25 at 03:00 AM

‘Marathon’ effort to refine end-of-life wound coding runs on McKnights Long-Term Care News; by Kimberly Marselas; 5/28/25 Two key wound care groups are finalizing a proposal for new codes that would help skilled nursing providers avoid newly created diagnoses gaps for end-of-life skin breakdown that could lead to missed reimbursement and potential liability risks. The push comes a year and a half after nursing homes won the right to stop coding wounds that occur as part of dying as pressure injuries, which can hurt their quality ratings. But they also lost any way to code or acknowledge treatment of such skin failure in the Minimum Data Set. ...

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Finding Solutions: Local group makes flowers for everyone

05/23/25 at 03:00 AM

Finding Solutions: Local group makes flowers for everyone WRDW-12 & WAGT-26, Augusta, GA; by Zayna Haliburton; 5/21/25 Flowers are something that can put a smile on someone’s face, whether you’re receiving or giving them. For one local group, they’re making bouquets to bring to nursing homes, shelters and hospitals. They’re now finding solutions in asking the community to consider donating their leftover flowers from weddings and events in order to brighten someone else’s day. “These are going to go to hospice patients that a part of Enhabit Augusta, ..." said Patricia Proctor, co-owner of El Rey and founder of non-profit Corazón Bonito ... which translates to "beautiful heart" in English. 

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Longtime Delaware Hospice CEO Susan Lloyd to retire

05/23/25 at 02:00 AM

Longtime Delaware Hospice CEO Susan Lloyd to retire Delaware Business Times, Milford, DE; by Jennifer Antonik; 5/21/25 Susan Lloyd says the team at Delaware Hospice took a chance on her 38 years ago when the young nursing administrator became its newest CEO. Now, she’s gearing up for a new challenge – retirement. Delaware Hospice first began offering services in the First State just five years before Lloyd took the role over after several organizational changeovers in that short amount of time. “There was a lot of nervousness about, ‘Is this CEO going to stay?’ I think I added some stability and home health care knowledge which I knew about from a previous position. This was a brand-new concept here and Delaware Hospice was just getting started. It was just a tremendous opportunity to grow hospice services throughout the state,” Lloyd recalled. ... Over the course of those 38 years of stability, the nonprofit she grew to love and cherish grew along with her, now boasting around 400 volunteers, more than 300 employees and programs going far beyond home-based hospice care to include a standalone hospice facility in Milford, as well as cardiac care, palliative care, dementia care, advance care planning and grief support.Editor's note: Susan, we thank you for your immeasurable contributions to the evolution and growth of hospice and palliative care. As you move into this new life-chapter, may we continue to learn from you and the excellence you ensured through Delaware Hospice.

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New Mexico legalizes medical use of psilocybin

05/22/25 at 03:30 AM

New Mexico legalizes medical use of psilocybin JD Supra; by Patrick Clark and Jennifer Pacicco; 5/20/25 On April 7, 2025, New Mexico became the third state to legalize psilocybin (colloquially known as “magic mushrooms” or “shrooms”) for medical purposes. New Mexico is the first state to legalize psilocybin via legislation and not a ballot initiative, like its predecessors Colorado and Oregon. Under the new law—the “Medical Psilocybin Act”—the following qualifying conditions are listed as eligible for psilocybin treatment: “(1) major treatment-resistant depression; (2) post-traumatic stress disorder; (3) substance use disorders; (4) end-of-life care.” The law also allows the New Mexico Department of Health to promulgate regulations that would add qualifying conditions to that list. ... Employers are not required to accommodate employees under the influence of psilocybin at work.

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“A different way of looking at how you can age in America”

05/22/25 at 03:15 AM

“A different way of looking at how you can age in America” AJMC; by Maggie L. Shaw; 5/21/25

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‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals

05/22/25 at 03:00 AM

‘We need you to work with us’: Home health providers renegotiate better Medicare Advantage deals Home Health Care News; by Joyce Famakinwa; 5/20/25 As Medicare Advantage (MA) enrollment continues to surge, home health providers have seen slim margins deteriorate further. Some providers have openly expressed their decision to reject financially unsustainable MA contracts. Abandoning unfavorable MA contracts may sometimes be necessary, industry executives told Home Health Care News. However, some providers have improved their MA standing by renegotiating rates or returning after walking away, leveraging data and understanding the needs of payer partners. “We have walked away, in specific states, from payers and Medicare Advantage groups because of rates and the inability to raise those rates, and pre-authorization terms,” G. Scott Herman, CEO of New Day Healthcare, told HHCN. 

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