Literature Review

Hospice utilization rebounds to pre-pandemic levels, but fraud casts a shadow Hospice News; by Jim Parker; 12/17/24 The nation’s hospice utilization rate among Medicare decedents has once again surpassed 50%, for the first time since the pandemic. However, fraud issues in the space create questions around the quality of care patients are receiving. Hospice utilization reached 51.7% in 2023, up more than two percentage points from the prior year, according to recent data from the Medicare Payment Advisory Commission (MedPAC). This is the highest rate since 2019. MedPAC observed increases in utilization across the board, even when stratified into subgroups by age, sex, race and rural or urban location. ... Despite these positive trends, an influx of new hospices continued in states considered hotbeds for Medicare fraud, including Arizona, California, Nevada and Texas. Many of these new additions came in areas where additional hospices were likely not necessary based on the needs of the patient population. Georgia also saw a large spate of new providers emerge in 2023.

Health gap at end of life is now wider in US than any other country Science Alert - Health; by Carly Cassella; 12/16/24 A data-crunching survey covering 183 member nations of the World Health Organization has now confirmed what some scientists feared: while years are being added to most people's lives, healthy life is not being added to most people's year. Researchers at the Mayo Clinic found that people around the world in 2019 were living 9.6 years of life burdened by disability or disease – an increase of 13 percent from 2000. In that same time frame, global life expectancy has increased 6.5 years, and yet health-adjusted life expectancy has only increased 5.4 years. In the US, the gap between lifespan and 'healthspan' is growing particularly wide. Between 2000 and 2019, life expectancy in the US increased from 79.2 to 80.7 years for women, and from 74.1 to 76.3 years for men. When adjusting for healthy years of added life, however, the span only increased by 0.6 years among men. And among women, while health-adjusted life expectancy fluctuated slightly over time, in 2019 it matched the figure seen in 2000. The expanding gap means if an American woman lived to the expected 80.7 years of age, the last 12.4 years of her life would on average be impacted by disease or disability.

You heard that correctly: Scammers are committing hospice fraud Federal Trade Commission - Consumer Advice; by Kira Krown, Consumer Education Specialist; 12/13/24 Did someone reach out and offer free, in-home perks like cooking and cleaning in exchange for your Medicare number? Don’t give it. That could be a scammer trying to commit hospice fraud.Scammers are targeting older adults — with calls, texts, emails, fake ads, and even door-to-door visits — claiming they’ll set you up with services like free cooking, cleaning, and home health care. What they likely won’t tell you is how: They want to commit fraud by signing you up for Medicare hospice — that’s right, hospice — care. Then, they can bill Medicare for all kinds of services in your name. Here’s what to know: ..Editor's note: Share this crucial information information from the Federal Trade Commission with communities you serve, your employees, and your volunteers. 

Helping Korean Americans with end-of-life planning is her passion Penn Medicine News; by Daphne Sashin; 12/10/24 Eunice Park-Clinton, DNP, MSN, MBE, is standing before a crowd of Korean American senior citizens, and she wants to talk about the end of life. ... Park-Clinton, a nurse case manager in the Hospital of the University of Pennsylvania’s Emergency Department and an assistant nursing professor at West Chester University, is undeterred. Speaking in Korean, she takes a kind but frank approach as she walks the seniors through life-sustaining treatments they might be offered in their final days and the need to decide what they will—and won’t—want for a dignified end of life.  ... As a Korean American herself, Park-Clinton’s passion for culturally sensitive planning comes from her personal familiarity with the community and its norms. In her work as a nurse, she has personally witnessed older Korean and other Asian immigrants experience health disparities due to their lack of knowledge of the concept.

HSPN Staffing Summit: Leveraging technology for person-centered care Hospice News; by Sophie Knoelke; 12/9/24 This article is sponsored by CareXM. This article is based on a virtual discussion with Kathleen Benton, President and CEO of Hospice Savannah. ... Dr. Benton has a master’s degree in medical ethics and a doctorate in public health. She has offered and reviewed many publications relevant to the topics of palliative care, ethics, hospice, and communication. [Dr. Benton:] I was schooled in clinical ethics and really mediating ethical dilemmas in health care. Looking at, is this in the best interest of the patient? Are we truly following the patient’s wishes? Many of the dilemmas, I would say a good 90%, occur at the end of life. ... [At] the root of [really trending] cases was one missing element. That element was the lacking area of communication. What do I mean by that? I believe that health care does the worst job of probably all other areas of communicating with folks. We have really taken what it is to be human out of what it is to treat a patient and a person. [Click on the title's link to continue reading this insightful discussion.]

From sleeping in cars to having an apartment: Season for Caring helps once-homeless families Austin American-Statesman; Austin, TX; by Nicole Villalpando; 12/8/24 When Thamairis Canales Yanez learned this year that she had been selected for the Austin-American Statesman's Season for Caring program, "what I did was thank God," she said. ... The 45-year-old and her 14-year-old daughter, Ivanna, came to the U.S. from Venezuela after Yanez's dental business was taken away by the government, and she feared for her daughter's life. She is trying to rebuild her life in America, but it has been difficult. At one point, she and Ivanna were living in her car. She has breast cancer that has spread to her brain. She is unable to work. Often when Season for Caring comes into the lives of the featured families, it is during one of their darkest times.  ...  "I have seen the impact on families," said Robin Clemons, chief development officer at Hospice Austin. "Imagine facing the end of life, and they can't pay their rent. (With Season for Caring funds) they don't have to worry about those types of needs. The stress for the caregiver, it relieves that burden."

Resources are expanding for older adults on their own California Healthline; by Judith Graham; 12/9/24 Jeff Kromrey, 69, will sit down with his daughter the next time she visits and show her how to access his online accounts if he has an unexpected health crisis. Gayle Williams-Brett, 69, plans to tackle a project she’s been putting off for months: organizing all her financial information. ... Until a few years ago, few resources were available for this growing slice of the older population. Now, there are several Facebook groups for solo agers, as well as in-person groups springing up around the country, conferences and webinars, a national clearinghouse of resources, and an expanding array of books on the topic. [Click on the title's link to read more.]

Dr. James O’Connell on caring for the homeless in Boston Simmons University, Boston, MA; by Simmons University; 12/6/24 “A mile from here, people are experiencing the same health disparities as they have in Third World countries,” said Dr. James O’Connell, founder and president of Boston Health Care for the Homeless Program (BHCHP) and Assistant Professor of Medicine at Harvard Medical School. ... In 1985, O’Connell was the founding physician of a program to support the people experiencing homelessness in Boston. The program received funding through a four-year grant from the Robert Wood Johnson Foundation and the Pew Charitable Trust. ... [Story about getting a homeless man into hospice care at a nursing home.] When [O'Connell] questioned him about hospice, Santo shared his perspective. “He told me, ‘I appreciate all you’ve done, but I didn’t know anyone there. I don’t want to die there. I want to die with my friends.’” After that, they arranged end of life care for Santo at the shelter. “I had never thought to ask him what he wanted,” said O’Connell. “I have since learned that I have to listen to what people want.” 

The ISNP opportunity for hospice providers  Hospice News; by Jim Parker; 12/5/24 Hospice providers can collaborate with institutional special needs Medicare Advantage plans (ISNP) to reach patients who reside in long-term care facilities. ISNPs restrict enrollment to MA eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care (LTC), skilled nursing facility, a LTC nursing facility, intermediate care facility for individuals with intellectual disabilities (ICF/IDD), or an inpatient psychiatric facility. The nonprofit senior services organization Empath Health, which operates several hospices, recently partnered with the MA organization American Health Plans to bring their services to ISNP-enrolled patients.

Aging and unhoused: What end-of-life care looks like Next Avenue; by Terry Ann Donner; 12/2/24 Karen Robyn is a 62-year-old homeless woman on disability; ... she fears dying alone on the streets or in a hospital hooked up to machines she doesn't want to use. ... For the 138,098 people aged 55 and older experiencing homelessness and 5 million older adults living below the poverty level, dying alone and unhoused is a real concern.  ... However, a viable solution has been quietly growing in communities across the country. Small nonprofit community homes provide hope for terminally ill people who do not have a reliable caregiver or a stable living environment. These small homes, usually caring for up to 4 to 10 guests at a time, provide "family" caregivers and a safe place to receive end-of-life care. They are developing outside of the health care system and receive no federal or state funding. Kelley Scott, executive director of the Omega Home Network and Clarehouse in Tulsa, Oklahoma, explains that the network's mission is to "foster the development of nonprofit community homes for people who are dying and have no caregiver support" due to a lack of family, homelessness or family dysfunction. The network has 135 members with 55 homes providing care and another 70 to 80 homes in development.

[England] Hospice leaders warn hundreds of beds out of use BBC News; by Hugh Pym; 12/4/24 About 300 hospice inpatient beds are currently closed or out of use in England, hospice leaders have warned. They say a lack of funding and staff are the primary reasons why some of England's 170 hospices have had to close beds permanently or take them out of use. Hospice UK, which represents the sector, is now calling for an urgent package of government funding to prevent further cuts. The Department of Health said it was looking at how to financially support hospices to ensure they are sustainable. ... Hospice UK says about 300 beds are closed or out of use in England - out of a total of 2,200 - and the number is increasing.  Editor's note: This report is the tip of the iceberg among news articles we regularly see from England about funding, lack of government support, and extreme fundraising (in comparison to the United States) in order to provide hospice services.

Homebound seniors living alone often slip through health system’s cracks KFF Health News; by Judith Graham; 12/2/24 Carolyn Dickens, 76, was sitting at her dining room table, struggling to catch her breath as her physician looked on with concern. “What’s going on with your breathing?” asked Peter Gliatto, director of Mount Sinai’s Visiting Doctors Program. “I don’t know,” she answered, so softly it was hard to hear. “Going from here to the bathroom or the door, I get really winded. I don’t know when it’s going to be my last breath.” Dickens, a lung cancer survivor, lives in central Harlem, barely getting by. She has serious lung disease and high blood pressure and suffers regular fainting spells. In the past year, she’s fallen several times and dropped to 85 pounds, a dangerously low weight. And she lives alone, without any help — a highly perilous situation. Across the country, about 2 million adults 65 and older are completely or mostly homebound, while an additional 5.5 million seniors can get out only with significant difficulty or assistance. ... It’s a population whose numbers far exceed those living in nursing homes — about 1.2 million — and yet it receives much less attention from policymakers, legislators, and academics who study aging.

Hospice of the Valley and CLS bridge the generation gap Arcadia News, Phoenix, AZ; by Cliff Summerhill; 12/1/24 Hospice of the Valley (HOV) and Christ Lutheran School (CLS) are entering the second year of a partnership that connects students with individuals at the Dementia Care and Education Campus. As part of HOV’s Adult Day Club, fifth-grade students visit individuals living with dementia to bridge intergenerational divides and spread enrichment, support, and joy that lasts long after the day’s activities have ended. ... Students partake in various meaningful activities with club members, including painting, coloring, gardening, and activities like cornhole, catch, and shuffleboard. The most important activity, however, is conversation. “Even though there is an age gap, both the Adult Day Club members and the students have the opportunity to learn from each other as they share stories and various interests,” CLS Service Learning Coordinator Mandi Schnepf said.