Literature Review

Palliative care in the ED reduces costs, improves patient outcomes Hospice News; by Jim Parker; 10/28/24 The presence of an embedded palliative care practitioner in the emergency department can significantly improve patient outcomes and reduce costs. A pilot program at the Michigan-based Corewell Health system in which a palliative physician was embedded in the ED effectively reduced inpatient mortality, readmissions, intensive care unit utilization and the total cost of care, while also boosting staff satisfaction, Lisa VanderWel, senior director for Corewell Health Hospice and Palliative Care, said during a presentation at the National Hospice and Palliative Care Organization (NHPCO) Annual Leadership Conference in Denver. ... “When you do really good palliative care, what happens?” she said during the presentation. “You have those [goals-of-care] conversations in a more timely manner. You have an earlier conversion to hospice. You avoid all the stress and crisis that’s involved if you wait until the last minute.”

Advance Directives: How to make sure your end-of-life decisions are followed Bottom Line Inc; by Mathew D. Pauley, JD; 10/24/24 Nearly 40% of older Americans have some form of advance directives, such as a living will to communicate wishes about life-saving treatment…or a medical power of attorney appointing a loved one as proxy if they’re incapacitated.  Problem: Your wishes may not always be followed in real-world situations. Examples: Emergency paramedics typically provide CPR to restart a patient’s heart even if that patient’s living will says otherwise. And complex medical circumstances at the end of life often arise that force your loved ones to make judgment calls about what you really want. Bottom Line Personal spoke to clinical ethicist Mathew Pauley about how to make sure hospitals, medical providers and family members follow your medical wishes.

New hospice special focus programAmerican Health Association / National Center for Assisted Living; by Amy Miller; 10/22/23 ​​As required under the Consolidated Appropriations Act of 2021, CMS has established a hospice special focus program (SFP) in the Calendar Year (CY) 2024 Home Health Prospective Payment System (HH PPS) final rule (88 FR 77676). Through increased regulatory oversight and enforcement of the selected poor performing hospice programs, the SFP will address issues that could place hospice beneficiaries at risk of receiving poor quality of care. The hospice SFP is like the current Special Focus Facility (SFF) program in place for nursing homes. As many nursing homes refer residents to hospice programs and may receive questions from residents or their families, it will be important to keep informed if there are noted quality of care issues. 

Who gets to access a “good death"? Adelphi University, New York; by Zainab Toteh Osakew and Jennifer McIntosh; 10/23/24Socioeconomically disadvantaged neighborhoods have fewer home hospice agencies, study shows. ... “We know that poorer neighborhoods have continued to lag behind in utilization of hospice care. For decades, scientists have attributed it to cultural values or preferences about care,” said Zainab Toteh Osakwe ’06, PhD, associate professor in the Adelphi University College of Nursing and Public Health and an expert in home healthcare. ... Dr. Osakwe partnered with a geospatial analyst at the University of North Dakota to uncover patterns in the locations of hospice offices. Drawing on information made publicly available by the Centers for Medicare and Medicaid Services, they culled data related to 3,447 hospice providers and 4,584 Medicare-certified hospices nationwide. Next, they geocoded hospice agency addresses to the social vulnerability index (SVI), a measure developed by the Centers for Disease Control and Prevention that geographically ranks at-risk communities. ... Dr. Osakwe and her team found that hospice agency offices were far more likely to be clustered in neighborhoods with greater socioeconomic advantage. Predominantly Black and Hispanic neighborhoods also contained significantly fewer hospice agency offices. While the results align with prior studies on hospice supply and community-level wealth, theirs is one of the first to investigate hospice agency availability by neighborhood.

YoloCares: State awards nearly $3 million to YoloCares The Enterprise; by Craig Dresang; 10/19/24 In a move to expand and deepen the regional safety net for people facing a serious or life-limiting illness, Davis-based YoloCares recently applied for, and secured, a nearly $3 million commitment from the State of California to add an Enhanced Care Management component to its portfolio of offerings. By design, ECM intends to address the social determinants of health  which are the nonmedical factors that influence health outcomes. ... [As] Medi-Cal looks towards a major transformation in the structure of benefits, ECM is the Golden State’s initiative to address a lack of palliative and supportive care services.  ... According to Lisa Adams, YoloCares’ director of patient access and palliative care, “Our clinical team is adept at responding to the complex and unique needs of our patients and their families, often going above and beyond the scope of typical palliative care to help our patients find comfort and dignity during health challenges and transitions. This funding and recognition from the state simply acknowledges and supports the work we have been doing all along.”

AAHPM Board President: Telehealth access ‘critical’ for hospice patientsHospice News; by Jim Parker; 10/17/24 The forthcoming expiration of telehealth flexibilities implemented during the pandemic could have a devastating impact on vulnerable populations, including those receiving hospice or palliative care. This is according to Dr. Holly Yang, board president of the American Academy of Hospice and Palliative Medicine (AAHPM). Currently, temporary federal rules allowing for greater access to telehealth are set to expire on Dec. 31. While legislation is in play to extend them, the outcome is uncertain, and the end of the year is approaching. Hospice News sat down with Yang to discuss the importance of these flexibilities and how their impending departure could impact patients and families, particularly those in rural areas or with limited mobility, poor health equity or social determinants of health needs.

Estes Park's only hospital joining UCHealth System Fort Collins Coloradoan; by Kelly Lyell; 10/17/24 Estes Park Health has started the process of joining the UCHealth System, with an expected starting date in the spring of 2025, the two organizations announced in a joint news release Wednesday. ... Estes Park Health has been financially challenged in recent years to maintain its services, the news release said, citing problems hospitals across the country have had keeping up with “dramatically increasing expenses, rising uncompensated care and minimal increases in reimbursements from Medicare and Medicaid.” As a result, the only hospital serving the Estes Valley, including visitors to Rocky Mountain National Park, has had to transfer or reduce its obstetrics, home health and hospice services.Editor's note: We've been following this story as but one of many examples of rural healthcare examples that result in reduced utilization for hospice services.

Stratis Health builds framework for expanding rural community-based palliative care Hospice News; by Jim Parker; 10/16/24 The health care performance improvement company Stratis Health has developed a framework for expanding access to palliative care in rural communities. The company’s strategy convenes resources and organizations that already exist in a given community to help meet patient’s palliative care, psychosocial, spiritual and social determinants of health needs. It leverages those resources to offer a wraparound suite of services for seniors and seriously ill patients. Hospice News spoke with Karla Weng, senior program manager for Stratis Health, about how health care providers and other stakeholders serving rural communities can come together to better serve their patients and clients. ... The field has shifted in more recent years, so that community-based really means anywhere but the hospital. It might be in a clinic. It might be home care. We’re not that prescriptive. So we have sometimes shifted to using the language “community centric.” The way that we work with communities who are interested in going down this path is helping them first to do a gap analysis and assessment of the resources that are already there in their community.  ... [Click on the title's link to continue reading.]

Death cafes: Demystifying the inevitable over tea and cookies MD edge - Internal Medicine News; by Megan Brooks; 10/15/24 “Death cafes” — where people gather to discuss death and dying over tea and cookies — have gained momentum in recent years offering a unique way for people to come together and discuss a topic that is often shrouded in discomfort and avoidance. It’s estimated that there are now about 18,900 death cafes in 90 countries, with the United States hosting more than 9300 on a regular basis. This trend reflects a growing desire to break the taboo surrounding discussions of death and dying. But these casual get-togethers may not be for everyone, and their potential benefits and harms may depend on who attends and who facilitates the discussion. ... [Click on the title's link to continue reading these significant cautions.]

Care utilization for neurodegenerative diseases compared to patients with cancer Physician's Weekly; 10/14/24 Neurodegenerative diseases are a leading cause of death, yet healthcare utilization and costs during the end-of-life (EoL) period are poorly understood.  Researchers conducted a retrospective study to describe and compare resource utilization among U.S. Medicare decedents with neurodegenerative diseases and cancer. ... The results showed 1,126,799 Medicare beneficiaries, of which 357,926 had a qualifying diagnosis. Individuals with neurodegenerative diseases were older and more frequently received Medicaid assistance than those with brain or pancreatic cancer. ... The study concluded that individuals with neurodegenerative diseases were more likely to visit ED and less likely to utilize inpatient and hospice services at the EoL compared to those with brain or pancreatic cancer. 

Millions of aging Americans are facing dementia by themselves California Healthline; by Judith Graham; 10/15/24 Sociologist Elena Portacolone was taken aback. Many of the older adults in San Francisco she visited at home for a research project were confused when she came to the door. They’d forgotten the appointment or couldn’t remember speaking to her. It seemed clear they had some type of cognitive impairment. Yet they were living alone. Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing? ... Portacolone got to work and now leads the Living Alone With Cognitive Impairment Project at UCSF. The project estimates that that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States. ... Imagine what this means. ...

Home health providers, CMS raise red flags over delayed access Modern Healthcare; by Diane Eastabrook; 10/11/24 Delayed home health access for Medicare beneficiaries is increasingly raising alarms from the Centers for Medicare and Medicaid Services and the home health industry as providers place blame on staff shortages and the program's reimbursement rates. More than a third of Medicare fee-for-service beneficiaries referred to home health following hospitalizations did not receive services within seven days of discharge, according to an analysis of 2023 Medicare claims from healthcare analytics company CareJourney. The report echoes a similar study published by the Commonwealth Fund in July, as well as concerns CMS raised about access in its proposed 2025 home health pay rule. ... Years of low Medicare reimbursements are taking a toll on the home health companies trade groups represent, said William Dombi, president emeritus of the National Association of Home Care and Hospice, which is part of the National Alliance for Care at Home, and Cunningham.

Helene will likely cause thousands of deaths over decades, study suggests USA Today; by Doyle Rice; 10/2/24 [Note the 10/2 date of this article. Helene's death toll is now 230+ and rising. Hurricane Milton's predictions were new.] A new study ... says that hurricanes and tropical storms are far deadlier than initial death tolls suggest. ... Overall, the death toll of a tropical cyclone may be a broader public health issue than previously thought, as disasters frequently trigger a domino effect of other threats to affected populations. ... Researchers found that these excess deaths were due to causes such as diabetes, suicide, sudden infant death syndrome or another cause that was not recorded. Cardiovascular disease was the next most common cause, followed by cancer. Official government statistics record only the number of individuals killed during these storms. Usually, these direct deaths, which average 24 per storm in official estimates, occur through drowning or some other type of trauma, according to the study. "People are dying earlier than they would have if the storm hadn't hit their community," said senior study author Solomon Hsiang, a professor of environmental social sciences at Stanford University. Looking at the death and destruction from Helene, Hsiang told the Associated Press that "Watching what’s happened here makes you think that this is going to be a decade of hardship on tap, not just what’s happening over the next couple of weeks.”