Literature Review

Nursing home ratings and characteristics predict hospice use among decedents with serious illnessesJournal of the American Medical Directors Association; by Ellis C Dillon, Chae Man Lee, Wenqi Gan, Doreek Charles, Germine Soliman, Julie Robison; 4/26Approximately one-third of older Americans experience a nursing home (NH) stay within 3 months of death, but it is unclear how NH characteristics influence end-of-life care.  Short-term (vs long-term) NH stays were associated with increased odds of hospice use and short hospice use. Individuals with long-term stays had lower odds of hospice use with stays at NHs with the highest (vs lowest) CMS ratings for quality measures and staffing ... Those with short-term stays had lower odds of hospice use with stays at NHs with the highest CMS Health Inspection ratings. People with long-term stays at NHs that were part of a chain, had Alzheimer's care units, or had more beds had increased odds of hospice care. Conclusions and implications: Among Connecticut Medicaid-insured decedents with NH stays, people with long-term stays and stays in NHs with better CMS ratings had lower odds of hospice use. Assistant Editor's note: This summary article highlights an important issue and an excellent opportunity for future analysis in a broader context. Intuitively, we'd like to see highly rated NHs have higher hospice utilization. 

Improving advanced practice clinicians' knowledge and comfort of physician orders for life-sustaining treatment form: A homecare quality improvement initiativeGeriatric Nursing; by Jeanette M Ruiz, Yvonne Y Wu, Kristen R Choi, Emily J Martin, Eden R Brauer; 4/26Many advanced practice clinicians (APCs) lack formal training on how to effectively discuss the Physician Orders for Life-Sustaining Treatment (POLST) with chronically ill older adults, often leading to communication gaps and delayed end-of-life decisions. This quality improvement initiative aimed to improve APCs knowledge and comfort in initiating and documenting POLST discussions with community-dwelling geriatric patients. A one-hour online training, incorporating didactic instruction, role-playing, and debriefing, was delivered for APCs providing home-based care. Surveys conducted before and after the training measured ... improvements ...  in POLST completion documentation ... , POLST discussions documentation ... , POLST upload documentation ... , hospice knowledge ... , palliative care knowledge ... , preparedness to discuss POLST ... , comfort with end of life conflict discussions ... , addressing religious/cultural perspectives ... , and use of structured communication frameworks ...

Social work involvement in advance care planning post US 2016 Medicare policy change: A systematic reviewBMJ Supportive & Palliative Care; by Peiyuan Zhang, Yixuan Wang, Jihyeong Jeong, Kaipeng Wang, John G Cagle; 4/26Since 2016, the US Medicare programme has reimbursed physicians and advanced practice providers for advance care planning (ACP) discussions; however, social workers-who play a critical role in ACP-remain excluded from reimbursement. Across studies, clinical social workers demonstrated strong knowledge of advance directives and reported high levels of confidence in facilitating ACP discussions. Most participants expressed positive attitudes towards ACP and viewed ACP facilitation as a core professional responsibility. Intervention studies suggested that social worker-led ACP initiatives may increase patient engagement in ACP, particularly completion of formal ACP documentation. These findings support ongoing policy discussions regarding the inclusion of social workers in ACP reimbursement frameworks.

Researchers at University of Pittsburgh target managed care (The state of hospice: Impacts on equity, quality, and nursing-an AAN consensus paper): managed care Insurance Newsnet; by a news reporter-staff news editor at Insurance Daily News; 4/24/26 ... This consensus paper examines the current state of hospice care in the US and the impact of changing hospice business models on health equity, healthcare quality, and nursing practice. Review of current literature and government policy statements related to hospice care and payment. Recommendations include updating policies to account for private equity involvement, evaluating current quality measures, addressing the existing Medicare Hospice Benefit, ensuring transparency and oversight for hospice agencies, and ensuring patient and caregiver education about hospice services.

Second-generation antipsychotics for depression in serious illness: A first-line augmentation strategyJournal of Pain & Symptom Management; by Gregg Robbins-Welty, Mia Pattillo, Danielle Chammas, Karolina Sadowska, Cara L McDermott, Nneka Ufere, Jason A Webb, Daniel Shalev; 3/26Depression in serious illness is common, disabling, and often requires rapid improvement. In the psychiatric literature, SGA [second-generation antipsychotics] augmentation improves response and remission rates ... , with onset of improvement within 1-2 weeks. Monotherapy is less well tolerated and not guideline-recommended. No RCTs have evaluated SGAs specifically for depression in serious illness, but numerous cancer trials support their safety for nausea, appetite, and other symptoms. Despite the absence of serious illness-specific psychiatric trials, SGAs have the strongest evidence base among augmentation options and may offer meaningful benefits when prognosis or symptom severity necessitates rapid improvement. Low-dose augmentation should be considered early, rather than only after multiple failed antidepressants, particularly when SGAs can also target co-occurring physical symptoms relevant to palliative care.

Discontinuation of medications with limited benefit at end of life in community-dwelling older veteransJournal of the American Geriatrics Society; by Joshua M Thorpe, Kelvin A Tran, Sherrie L Aspinall, Shelli L Feder, Brystana G Kaufman, Ann Kutney-Lee, Maria K Mor, Loren J Schleiden, Florentina E Sileanu, Carolyn T Thorpe, Courtney H Van Houtven; 4/26Discontinuation of medications with limited benefits (LBM) in patients nearing the end of life can reduce burden, adverse events, and costs, and enhance quality of life. However, most research on end-of-life prescribing has focused on nursing homes or hospice settings. [This study setting was] community-residing, non-hospice older veterans. Among community-dwelling older veterans in their final year of life, 73% were receiving at least one LBM at the start of that year, and 78% of these individuals continued LBM use until death. These rates parallel those reported in long-term care populations and underscore the need for community-based healthcare providers to routinely screen for LBMs and support appropriate medication discontinuation in older patients with advanced illnesses and limited life expectancy.