Literature Review

Nursing homes can disrupt ‘rehabbed to death’ cycle with PDPM-based palliative care Skilled Nursing News; by Kristin Carroll; 9/7/25 ... Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in which people commonly go through several care transitions near the end of life, driving up costs across the health care system while patients receive services that are not aligned with their own goals. Enabling concurrent SNF and hospice care is one change that could lead to improvement. These are assertions in the recent article “Rehab and Death: Improving End-Of-Life Care for Medicare Skilled Nursing Facility Beneficiaries,” published in the Journal of the American Geriatrics Society.

The hidden crisis in serious illness care and how we fix itMedCityNews; by Dr. Mihir Kamdar; 9/7/25 Every year, millions of Americans with serious illnesses find themselves caught in a dangerous limbo: not sick enough to qualify for hospice, but far too ill to be served by our traditional healthcare system. The result is care that’s expensive, fragmented, and often traumatic. These patients are shuffled between a revolving door of emergency rooms and ICUs, enduring a cascade of aggressive interventions that don’t match their goals or improve their quality of life. This approach not only undermines quality, it drives healthcare spending through the roof, particularly in the last year of life. This is the hidden crisis in serious illness care. And it’s getting worse. At the root of the problem is what many in the field call the “hospice cliff.” ...

[France] Palliative care for solid organ transplant candidates and recipients: A scoping reviewTransplantation Reviews; by Liesbet Van Bulck, Fiona Ecarnot, Mathilde Giffard; 8/25Solid organ transplant patients experience high morbidity and mortality before and after transplantation. International guidelines recommend integrating palliative care into the management of patients with advanced organ failure, including transplant candidates and recipients, as it supports advance care planning, enhances communication and improves symptom management. This scoping review shows that palliative care for organ transplant has received little attention heretofore.

Palliative care use and end-of-life care quality in HR+/HER2- metastatic breast cancerBreast Cancer Research and Treatment; by Julia G Cohn, Susan C Locke, Kris W Herring, Susan F Dent, Thomas W LeBlanc; 8/25Metastatic breast cancer (MBC) is incurable, despite therapeutic advances, especially in hormone receptor positive (HR+) and human epidermal growth factor-2 negative (HER2-) disease. Of 102 patients, 85 died during the study period, and over half (55%) received aggressive EoL [end of life] care. Half had some form of SPC [specialist palliative care], and rates of aggressive EoL care were comparable between those who engaged with SPC and those who did not. The most common indicators of aggressive EoL care included multiple ED visits (28%) and hospital admissions (23%) in the last 30 days of life as well as in-hospital location of death (24%). Although 72% enrolled in hospice care, 9% of patients were on hospice for ≤ 3 days. This real-world study demonstrates that many patients with HR + /HER2- MBC [metastatic breast cancer] receive aggressive EoL care despite some engaging with SPC and many enrolling in hospice. 

Why palliative care is more than just end-of-life support MedPageToday's KevinMD.com; by Dr. Vishal Parackal; 9/1/25 ... Palliative care as a system requires strong interpersonal and cross-specialty communication for smooth functioning, as patients may require expert opinions from different fields to optimize their treatment plan. Patient education for systemic follow-ups and establishing a baseline of knowledge regarding their diagnosis and potential danger signs helps create a better environment for holistic care. While we focus on the physical aspects of care and diagnosis, we often fail to realize the psychological and mental impact that such conditions can have on the patient and their family. ... The opportunity to make a meaningful difference in patients’ lives by easing their suffering and enhancing their quality of life is profoundly fulfilling. ... Editor's Note: Excellent descriptions of palliative care.

Palliative care and liver disease: Understanding hepatitis and beyond Ashland LocalTownPages, Aubrey, TX; by Press Services; 9/1/25 Sovereign Hospice, a woman-led hospice care provider serving the Dallas-Fort Worth Metroplex, offers specialized liver disease support programs. The organization also provides targeted hospice home care services and palliative care programs designed specifically for patients facing hepatitis and other advanced liver conditions throughout North Texas.

Trends in hospice and palliative care consults initiated in the emergency department: An eight-year utilization analysisThe American Journal of Emergency Medicine; by Satheesh Gunaga, Abe Al-Hage, Alyssa Buchheister, Harish Neelam, Jessica Corcoran, Michael Welchans, Kirby Swan, Mahmoud Awada, Joseph Miller, Fabrice Mowbray; 8/25Emergency departments (EDs) play a central role in end-of-life care, yet the early integration of hospice and palliative care (HPC) is often underutilized. A total of 8,055 HPC consults were ordered for 6,370 unique patients. The average age was 78.1 years, with 56.4 % female and 75.0 % White. Of the cohort, 91.7 % were admitted, 5.3 % discharged home, and 53.2 % died in-hospital. HPC consults increased from 369 in 2016 to 1,355 in 2023 (367 % increase ... ). The ratio of hospice to palliative care consults reversed from 1.5:1 in 2016 to 1:1.9 in 2023.

[Canada] Palliative care access and use among homeless individuals: A scoping reviewBMC Palliative Care; by Ashley Rodericks-Schulwach, Ravi Gokani, Lynn Martin; 7/25Homeless individuals experience unique needs and challenges when PC. Many of the challenges experienced are related to the stigma of homelessness– it negatively impacts the relationship people have with PC professionals as well as creates barriers to access. Implementation of integrated and intersectoral PC programs that employ harm reduction approaches is needed to ensure that people experiencing homelessness receive PC that promotes dignity and comfort. Specialized staff training to work with this population is also needed to improve quality of PC care provided. Future research that employs an intersectional lens to better understand the needs of sub-groups within the homeless population is needed, as is use of consistent terminology related to PC services to ensure both understanding and generalizability of findings. 

Unity receives $25,000 grant from K.C. Stock Foundation to expand home-based palliative care service The Chamber - Manitowoc County, WI; 8/14/25 Unity is honored to announce the award of a $25,000 grant from the K.C. Stock Foundation to support its Supportive Care Management (SCM) program, which provides compassionate, home-based palliative care to individuals in Northeast Wisconsin facing serious illness. “We are deeply grateful to the K.C. Stock Foundation for recognizing the growing need for accessible palliative care,” says Unity Executive Director Alisa Gerke. ... Unity’s Supportive Care Management program provides an extra layer of support and education for individuals and their family when living with a serious illness, delivering expert care wherever a patient calls home. 

Standardized assessment of patient experience in pediatric palliative care: A national collaborationJournal of Pain & Symptom Management; by Ashley K Autrey, Stacey Rifkin-Zenenberg, Tracy Hills, Jennifer Salant, Rachna May, Elliot Rabinowitz, Chelsea Heneghan, Laura Drach, Emma Jones, Rachel Thienprayoon; 7/25Use of patient reported outcome measures (PROMs) are crucial to providing patient-centered care. In 2022, the Pediatric Palliative Improvement Network developed a project to standardize the assessment of patient experiences with PPC [pediatric palliative care] services. Results: Patients/ families felt heard and understood and would recommend PPC. Standardized assessments of patient experience with PPC are feasible and informative. PROMs can ensure that PPC services meet patient needs, identify opportunities for improvement, and demonstrate value.

Building a strong foundation for pediatric palliative care in Connecticut Solomon Center for Health Law and Policy at Yale Law School, Targeted News Service; by Wendy Jiang, Elle  Rothermich, Eugene Rusyn; 8/12/25 The Solomon Center for Health Law and Policy at Yale Law School has released a white paper outlining concrete pathways for Connecticut to guarantee pediatric palliative care (PPC) from diagnosis--not only at end of life--while building a workforce equipped to deliver it statewide. The report highlights two foundational barriers: coverage that generally triggers only when a child receives a six-month terminal prognosis, and a shortage of clinicians trained in primary palliative skills, leading to delayed referrals and fragmented support for families facing serious childhood illness. The authors recommend two primary coverage strategies for the state.Editor's Note: Though written for Connecticut, this 42-page white paper from Yale provides excellent information and recommendations to examine for one's own state. Its sub-title is "Establishing a statewide coverage pathway & expanding primary palliative care education for pediatric clinicians."

State Medicaid coverage policies for community-based palliative care: Lessons from NASHP’s State Institute National Academy for State Health Policy; by Ella Taggart, Wendy Fox-Grage; 8/11/25 Six states recently participated in NASHP’s two-year State Policy Institute to Improve Care for People with Serious Illness (the Institute): Colorado, Maine, Maryland, Ohio, Texas, and Washington. ... Specifically, the six participating states received guidance on policy mechanisms to cover palliative care services in the community and completed cost analysis on palliative care services for Medicaid beneficiaries. While all the states balanced the same forces and demands, ... each state modeled a benefit that was responsive to its particular needs and circumstances. ... CBIZ Optumas and TFA Analytics then designed a cost calculator for each state to help with different scenarios. 

The state of pediatric concurrent hospice care in the United States American Academy of Pediatrics; by Meaghann S. Weaver, MD, PhD, MPH, HEC-CCorresponding Author; Steven M. Smith, MD; Christy Torkildson, PhD, RN, PHN; Deborah Fisher, PhD, RN, PPCNP; Betsy Hawley, MA; Alix Ware, JD, MPH; Holly Davis, MS, APRN; Conrad S. P. Williams, MD; Lisa C. Lindley, PhD, RN, FPCN, FAAN; 8/1/25 The Patient Protection and Affordable Care Act (ACA) required all state Medicaid programs to pay for both curative and hospice services for children and adolescents. The purpose of this Special Article report is to quantify and describe the use of concurrent care for children, including a depiction of the barriers and benefits according to community-based hospice organizations in the United States. A total of 295 hospice organizations from 50 states and Washington, DC responded to the National Alliance for Care at Home call for engagement.