Literature Review

Sierra Hills employees strike for safer conditions to live and work Wyoming Tribune-Eagle, Cheyenne, WY; by Noah Zahn; 12/26/24 Employees at Sierra Hills Assisted Living protested Thursday outside the facility after Edgewood Healthcare, which owns Sierra Hills, has refused to budge in negotiations for safer working conditions for employees and residents after more than 10 months of negotiation. “We did include many things in our contract proposal that we feel will really benefit the residents,” said Taylor Ewig, who has been a CNA at Sierra Hills for around 10 years. ... There are currently between 70 and 80 residents at the facility and around eight under hospice care. Ewig and other CNAs participating in the strike said that many of the Sierra Hills residents are supportive of the strike. The issues began at the facility when Sierra Hills implemented a hospice care service a few years ago, shortly after the onset of the COVID-19 pandemic. ... The company hires hospice nurses who are only on the facility about two hours per week, according to Sierra Hills staff. The rest of that time, the burden of care for the resident falls to the staffed CNAs and RNs.

'We do more than just pray': Chaplains take active role at Milwaukee VA and in community U.S. Government Veterans Administration; by David Walter; 12/23/24 If you think hospital chaplains just pray at bedsides, think again. At the Milwaukee VA Medical Center, chaplains are much more than comfort providers. They are fully integrated into the everyday workings of the hospital, serving on committees, participating in numerous events and consulting with other subject matter experts. Their work also goes beyond the walls of the hospital, interfacing with the community to help better reach those Veterans who may not venture into the hospital. And while they continue to meet one-on-one with patients on a daily basis, they also extend their services to hospital staff, providing solace and support for those dealing with the emotional toll that caregiving can sometimes take on health care professionals. “There’s been a really big shift here,” said Chaplain Robert Allen, chief of the Milwaukee VA’s Chaplain Services, adding that for too long chaplains were “put in this corner, thinking that we only just pray.” Editor's note: To strengthen your understanding of chaplaincy roles, standards, training, and certification, examine the national Association of Professional Chaplains.

How UCSF Health is rebuilding an 'instrumental' management layer Becker's Hospital Review; by Kelly Gooch; 12/17/24Middle managers have long played a crucial role in industries across the U.S. However, a November article from global management consulting firm Korn Ferry describes "a disappearing layer of middle management," particularly among professional-service firms that are "delayering" to improve flexibility and responsiveness. ...  [Data] shows that in 2023, middle managers accounted for 31.5% of all layoffs, with an average of 22% between 2018 and 2022. While Mitul Modi, Korn Ferry senior client partner in the firm's global healthcare services practice, said layoffs of managers have occurred at various health systems in 2024, he told Becker's he is not seeing this occur with patient-facing roles. Instead, he has observed an increased emphasis on developing middle managers. ... One example of this is San Francisco-based UCSF Health. ... UCSF Health's efforts center around investing in a management core training program.[Click on the title's link to continue reading.]

Palliative medicine for the community paramedic Journal of Emergency Medical Services (JEMS) - The Conscience of EMS; by Maurice Paquette; 12/17/24 The role of the paramedic is evolving. ... EMS has become a catch-all, a gateway into a somewhat—if not totally—fractured healthcare system. ... The landscape of healthcare is shifting as well. The pandemic, coupled with the realization of self-care, well-being, and mental health struggles has caused drastic reduction in the number of healthcare workers, and the amount of experience in skills that those healthcare workers carried with them. ... Over the past many years, we’ve seen a push for the idea of the community paramedic, as well as mobile healthcare. The establishment of a community paramedic program, especially in rural areas of the United States, would provide non-emergent care, under expanded scope and under the direction of a physician in the patient’s home.  According to a literature review in the International Journal of Paramedicine, the most common community paramedic program goals are to “aid patients in chronic disease management, reduce emergency department visits, reduce hospital admissions/readmissions, and reduce Healthcare costs.” Editor's note: Pair this with the article we posted yesterday, Characteristics of patients enrolled in hospice presenting to the emergency department.

What they love and loathe: Medscape Nurse Career Satisfaction Report 2024 Medscape; by Jon McKenna; 12/13/24 Despite well-publicized issues buffeting their profession, nurses in a Medscape survey overwhelmingly said they are happy with their career choice, and most said they would make it again. They also told us about their most- and least-favored job features, recounted any experiences with abuse at work, revealed possible alternative careers, and reported union membership, among other insights. [Click on the title's link to continue reading.]

Design work to prevent burnout: A new model for improving work design supports change that increases employee engagement and reduces stress MIT Sloan Management Review; by Sharon K. Parker and Carline Knight; 12/10/24... In the U.S., 67% of workers report feeling disengaged from their work, and 49% intend to leave their current job. ... In this article, we’ll introduce readers to our SMART Work Design model. This model captures and synthesizes the most important characteristics for worker well-being and performance from both the Jobs Characteristics and Job Demands-Resources models into five dimensions: stimulating work, mastery, autonomy, relational work, and tolerable demands (thus the SMART acronym). HR leaders, managers, and employees can use the model to identify aspects of work that lead to disengagement and burnout and then create a healthier work environment and improve performance. (See “A Model for Making Work Smarter.”)

[CAPC] 2024 Serious Illness ScorecardCenter to Advance Palliative Care press release; 12/4/24America’s readiness to meet the needs of people with serious illness. A state-by-state look at palliative care capacity. How does your state rate? How can I improve my state’s rating? Download the full report.

Washington Paid Family and Medical Leave & Job Protection - Final Legislative Report University of Washington, Daniel J. Evans School of Public Policy & Governance; Lead investigator Heather D. Hill, MPP, PhD, with Tom Lindman, MPP, Diane Rucavado, MPA, and Elizabeth Ford, JD; 12/1/24 This research was funded by ESSB 5187. Additional support for data access and analyses for this research came from the UW Data Collaborative funded by the UW Population Health Initiative, UW’s Student Technology Fee program, the UW’s Provost’s office, and Eunice Kennedy Shriver National Institute of Child Health and Human Development research infrastructure grant, P2C HD042828 to the Center for Studies in Demography and Ecology at the University of Washington. The content is solely the responsibility of the authors.

[Canada] Feasibility of prospective error reporting in home palliative care: A mixed methods studyPalliative Medicine; Allison M Kurahashi, Grace Kim, Natalie Parry, Vivian Hung, Bhadra Lokuge, Russell Goldman, Mark Bernstein; 10/24 Palliative care patients may be particularly vulnerable to experiencing errors due to the complex communication among interdisciplinary team members (including the patient and their caregivers), the use of high-risk medications such as opioids and benzodiazepines, polypharmacy, patient frailty, and patient cognitive decline. Care in patients’ homes presents additional challenges to patient care that are unique from hospital settings: Decreased communication about roles and responsibilities in care can result from involvement of multiple care teams and different electronic records. The collaborative nature of care in a home-based palliative care context may present unique challenges to translating error reporting to improved patient safety. Physicians are amenable to error reporting activities so long as data is used to improve patient safety.

[UK] Multiple points of system failure underpin continuous subcutaneous infusion safety incidents in palliative care: A mixed methods analysisPalliative Medicine; Amy Brown, Sarah Yardley, Ben Bowers, Sally-Anne Francis, Lucy Bemand-Qureshi, Stuart Hellard, Antony Chuter, Andrew Carson-Stevens; 10/24 About 25% of palliative medication incidents involve continuous subcutaneous infusions. Complex structural and human factor issues make these risk-prone interventions. Primary incidents (most proximal to patient outcomes) leading to inappropriate medication use (including not using medication when it was needed) were underpinned by breakdowns in three major medication processes: monitoring and supply ... administration ... and prescribing ... Recurring contributory factors included discontinuity of care within and between settings, inadequate time, inadequate staffing and unfamiliarity with protocols. Psychological harms for patients and families were identified. System infrastructure is needed to enable timely supply of medication and equipment, effective coordinated use of continuous subcutaneous infusions, communication and continuity of care.

In 2023, the majority of home health aides and personal care aides were women U.S. Bureau of Labor Statistics - TED: The Economics Daily; 11/13/24 In honor of National Home Care and Hospice Month, we are highlighting data about two of the most common occupations that provide care to people with illnesses or disabilities in a home or community-based setting—home health aides and personal care aides. In 2023, women accounted for 87 percent of all home health aides and 80 percent of personal care aides. Workers in these two occupations assist people with activities of daily living (such as feeding or bathing), though home health aides generally focus more on their patients’ health and safety, while personal care aides often assist with other tasks (such as errands and housekeeping). Across all occupations, 47 percent of workers were women. Home health aides and personal care aides were more likely to be Black or African American (30 percent and 25 percent, respectively) than were workers overall (13 percent). Forty-two percent of home health aides and 27 percent of personal care aides were foreign born, higher than the average of 19 percent for workers overall. ... [Click on the title's link to continue reading.]

National program helped 27 states develop background check processes for long-term care McKnights Senior Living; by Kimberly Bonvissuto; 11/11/24 A national background check program was so successful in helping states develop or enhance systems for conducting background checks of prospective long-term care employees that more than a quarter million prospective employees were disqualified from working in the sector, even after funding for the program ran out, according to a final report on the program. The US Department of Health and Human Services Office of Inspector General released a final analysis on Thursday of the National Background Check Program for long-term care providers. The agency reported that 29 states participated in the program between 2010 and 2024 and that the program helped 27 of them develop programs to identify efficient, effective and economical procedures for conducting background checks on prospective long-term care employees. During the National Background Check Program, states disqualified at least 106,000 individuals with criminal convictions from employment. Disqualifying criminal convictions included offenses of murder, assault, battery, robbery, theft, fraud and forgery.