Literature Review

When the end of life feels like a beginning: a hospice encounter raises questions medicine can't answerBroadview; by Ralph Klose; 9/8/26 As a retired neuropsychologist and longtime hospice companion, I often wonder what can still be measured at the end of life — and what cannot. ... Magda had lived in the hospice for three months. A former violinist, she rarely spoke about her past. But her hands still moved in gentle arcs, as if drawing invisible phrases from the air. ... One afternoon, I entered her room and paused. The air felt different — not cold, not scented, but bright. The blinds were closed. No sunlight entered. And still, the space around her shimmered faintly, like a curtain of breath. Her skin looked translucent. Her lips moved, but no sound came. Later, as I sat quietly at her bedside, a nurse whispered, “She’s speaking with someone.” There was no theology in her gestures. No visions of angels. But something had changed — as if a second world had unfolded beside the first, not replacing it, but resting gently alongside. ...

Central Illinois nursing home fined $25K by state after resident's death Pekin Daily Times, Perioa, IL; by Zach Roth; 9/6/26 A Canton nursing home was fined $25,000 after a resident died last year after being taken off medication that was prescribed to prevent blood clots. ... On March 31, 2025, a verbal order was given to stop providing Xarelto because the woman began hospice care one month prior. ... The care plan noted that she had a history of strokes and that medication needed to be provided as ordered by her doctor. ... The hospice's owner said that the power of attorney had contacted them after the woman had died asking about the medication situation, noting that they hadn't seen anything to show that her Xarelto had been discontinued. The hospice owner also said that they hadn't received an order from a hospice physician or nurse to discontinue it. Editor's Note: Details are more complex than space allows in the short summary above. A verbal order to stop a medication, without a documented physician directive or clear communications with the family, is a quiet risk hiding in plain sight at hospice transitions — one that can hasten death rather than ease it. Deprescribing has its place in end-of-life care, but only through structured, physician-ordered, shared decision-making. Does your hospice's process protect against this, or could it happen to one of your patients tomorrow? 

Nearly half of veterans with stage IV cancer die without hospice: a national VHA analysis of 45,397 decedents Medscape; by Sasmith Menakuru, MD; Alexander Quattlebaum, MD; Chance Bloomer, MD; Lara Khoury, MD; Abdulsabur Sanni, MD; Michael Goodman, MD; 9/3/26  Results: Of 45,937 veterans, 20,338 ... had no hospice admission or consultation.  ... Conclusions: Hospice access for veterans with Stage IV cancer deteriorated during COVID-19 and shows no meaningful recovery; ... These findings identify Stage IV hospice access as an underrecognized national VHA quality priority warranting Stage IV—triggered automated palliative care consultation, embedded outpatient palliative care in oncology clinics, standardized referral protocols at documented progression, and veteran/family-facing hospice education. This analysis establishes a statistically rigorous national baseline for benchmarking interventions–and a call to action for the VHA oncology community to restore hospice as a core element of veteran-centered end-of-life care.

Priorities for advancing palliative care for Amyotrophic Lateral Sclerosis: a consensus report from a palliative care for ALS working group in the United States Muscle & Nerve; by Kara E. Bischoff, Yaowaree L. Leavell, Jessica M. Besbris, Christi Lero, Kelsey Noble, Astrid Grouls, Jerome Kurent, Benzi M. Kluger, Steven Z. Pantilat, Ambereen K. Mehta, on behalf of the International Neuropalliative Care Society's Palliative Care for ALS Working Group; 8/31/2026 The Palliative Care for ALS Working Group was formed within the International Neuropalliative Care Society, consisting of interprofessional ALS and palliative care clinicians, researchers, advocates, and patients and care partner representatives who are committed to improving palliative care for people living with ALS. The group engaged in a strategic planning process to determine what is needed to advance palliative care for people with ALS over the next 3–5 years. This report outlines the core recommendations from that strategic planning process. Recommendations are divided into five sections: (1) clinician education, (2) clinical service expansion, (3) research, (4) public awareness, and (5) policy change. Editor's Note: ALS is an especially devastating, demanding disease for patients, caregivers and families, for your clinical staff and volunteers. What disease-specific education and resources do you provide? How many ALS patients have your organization served in "x" years? Do you partner in any way with your regional ALS association? For non-clinical leaders, an important, easy distinction for you to remember the clinical, deeply personal differences between ALS versus ALZ: 

The death I feared, and the peace I found Gillette News Record; by Michelle Mathal; 8/29/26 ... From the dreaded day my brother was diagnosed, to two years later when my parents tragically died in a car accident and I surfaced from the glacial water knowing I had to live to be his caregiver, to grieve alone. ... We enrolled in hospice earlier than most because Tomas was falling and losing movement in his left hand. ... No one told me that caring for a dying person would be so intimate. When I dressed him in the morning, I realized we had the same hands and feet, big enough that we should’ve been a foot taller. No one told me about the deep trust between caregiver and patient. It is a sacred pact not bound by blood, but an understanding that we would be seen at our most vulnerable and sensitive times, but not judge each other for these moments, but respect one another despite them.

I lost my sister to cancer. Here’s what I learned about medically assisted death. The Washington Post; by Steven Petrow; 8/29/26 The same year that my parents died, my sister, Julie, then 55, was diagnosed with advanced ovarian cancer. Five years and three recurrences later, she’d exhausted all viable treatment options. At that point, she’d undergone one nine-hour surgery, six courses of chemotherapy and had joined two clinical trials. Like my parents’ physicians had done, Julie’s doctor eventually recommended palliative care, with at-home hospice, to keep her comfortable during her last months. ... [Julie, 61, chose legal MAID in 2023.] Approaching MAID as a journalist, I had questions: How is eligibility determined, what are the safeguards, does it always work, is a health care professional involved and many others. As a brother, however, I was conflicted and confused, and my questions felt more urgent and personal. ... [Access might be limited by a paywall.]  

The sandwich generation confronts the caregiver crunch: Sonia’s story IndiaCurrents; by Snigdha Sen; 8/28/26 The Indian American community is aging. As the U.S. faces a severe caregiver shortage, the community faces an even greater challenge: finding culturally and linguistically appropriate care. The Aging with Dignity project looks at efforts within and beyond the Indian community to help the "sandwich generation" care for aging parents. This is Part 1 of a three-part series.

My grandparents wanted to age at home. Eventually, their care cost $4,000 a week. Business Insider; by Erin Dentmon; 8/25/26 My grandparents lived at home until dying in their 90s in 2024 and 2025. Like many people, they had no desire to leave their shared home at the end of their lives. ... Through great sacrifice, my mom and her siblings worked to make that happen for them. My grandparents, a rural, middle-class couple, benefited from an increasingly unique set of circumstances: Their end-of-life illnesses were relatively short. My grandfather's pension provided financial security. Most importantly, they had six adult children ready to pitch in to make it happen. Even with all of these advantages, caregiving was complicated.

Aging Luzerne County prison population cited as challenge The Dallas Post; by Jennifer Learn-Andes; 8/22/26 During recent legislative testimony about crime trends, Luzerne County Manager Romilda Crocamo highlighted the aging prison population as a concern that must be addressed. Older inmates with “escalating chronic health needs” are contributing to rising medical costs and challenging a prison staff “increasingly called upon to manage geriatric and end-of-life care in a setting never designed for it,” she told the Senate Majority Policy Committee and House Republican Policy Committee at a hearing earlier this month in Hazleton. “Corrections officers are trained for security, not hospice care,” Crocamo told the legislators, emphasizing “graying behind bars” is an emerging issue statewide. 

Doctors say they feel pressured to prioritize corporate interests over patients: report HealthcareDive; by Jill Hughes; 8/21/26 Corporate entities, including hospitals and health plans, now employ more than 80% of physicians nationwide, according to the Physicians Advocacy Institute.

In a recent study, most oncologists chose not to assist patients in dying Cancer Therapy Advisor; by Jason L. Harris; 8/19/26 Most oncologists asked to consult with a terminally ill patient seeking medical aid in dying (MAID) choose to opt out, according to research published in JAMA Network Open. In a California-based study, researchers found high rates of oncologists opting out, forcing many patients to pursue MAID with physicians they did not know. Further, a small number of physicians were responsible for most MAID-related prescriptions. “Our dataset likely underestimates these challenges, as it only includes patients who successfully found an attending physician and does not capture instances when opt-out was not documented,” the researchers added.

If you lost a spouse/domestic partner in recent weeks read this today AfterTalk; by Larry Lynn; 8/17/26 I remember when I lost my first wife 30+ years ago, and recall how unprepared I was to deal with financial issues in the moment. I made mistakes that cost me later, so let me keep this simple. ... 

Dementia coach Jeannine Forrest of Through the Forrest recently featured on Close Up Radio EIN Presswire, Chicago, IL; by Close Up Television & Radio; 8/17/26 Jeannine Forrest still remembers the moment her mother looked at her in her own home and said, “I’m living in a house of strangers.” At that moment, as a registered nurse, she realized she was not prepared to understand what her mother was truly experiencing. That realization became her life’s work. More than 30 years later, Forrest is a dementia coach and founder of Through the Forrest, where she works directly with family caregivers. ... Forrest explains that dementia shows up differently in every person, and is much more than memory loss alone. Her approach rests on one idea: When families understand what is happening, have a plan, and feel supported, life can become less frightening and more meaningful for both the person living with dementia and the caregiver.