Literature Review

Dementia patient discharged from hospice over Medicare requirement. Here’s why it happened WKMG-6, Deltona, FL; by Erika Briguglio and Louis Bolden; 5/14/25A Volusia County family is left scrambling after their loved one is abruptly dropped from hospice care. To qualify for hospice, patients must have a life expectancy of six months or less. However, for dementia patients, the prognosis can be unpredictable. Hospice care can be extended as long as the patient continues to meet Medicare requirements. Unfortunately, these requirements are why Amy Yates lost coverage for her 91-year-old grandmother. ... “I think it’s she hasn’t died fast enough, and it’s costing them money that they don’t want to spend,” Yates told News 6. ... What Yates’ family is dealing with is what Medicare calls live discharge, and they are not alone. The Hospice Foundation of America reports that 17% of people in 2022 who were admitted to hospice care were discharged; about 6% of the total caseload was discharged because they no longer met Medicare requirements for care under the hospice benefit.Editor's note: What are your hospice stats for live discharges? For Length of Stay (LOS)? This factor--with the face-to-face recertification requirement--is crucial. Unfortunately, many hospices misused President Jimmy Carter's extraordinarily long LOS with misleading information about hospice care. They watered down "end-of-life" care and never mentioned anything about a basic recertification process. Warm, user-friendly language can be used with integrity, authenticity, and patient/caregiver support.

AI tool uses face photos to estimate biological age and predict cancer outcomes Mass General Brigham - Technology & Innovation - Research; by Hugo Alerts, Ray Mak, Dennis Bontempi, Osbert Zalay, Danielle S. Bitterman, Fridolin Haugg, Jack M. Qian, Hannah Roberts, Subha Perni, Vasco Prudente, Suraj Pai, Christian Guthier, Tracy Balboni, Laura Warren, Monica Krishan, and Benjamin H. Kann; 5/8/25 Mass General Brigham findings suggest FaceAge tool could provide objective data to help inform treatment decisions in cancer care and other chronic diseases. Eyes may be the window to the soul, but a person’s biological age could be reflected in their facial characteristics. Investigators from Mass General Brigham developed a deep learning algorithm called FaceAge that uses a photo of a person’s face to predict biological age and survival outcomes for patients with cancer. They found that patients with cancer, on average, had a higher FaceAge than those without and appeared about five years older than their chronological age. Older FaceAge predictions were associated with worse overall survival outcomes across multiple cancer types. They also found that FaceAge outperformed clinicians in predicting short-term life expectancies of patients receiving palliative radiotherapy. Their results are published in The Lancet Digital Health.Editor's note: This summary article is published by the main source, Mass General Brigham. Various articles are being written about this new use of AI.

I held my wife's hand as she died. It was the most painful moment in my life, but also the greatest gift.Yahoo!Life; by Juan Cruz, Jr.; 4/13/25

A daughter’s cautionary elder care tale The Progressive Magazine - Book Review; by Bill Lueders; 5/12/25 The call that woke Judy Karofsky in the middle of the night on May 18, 2015, was from a hospice nurse, who got right to the point: “I’m calling to tell you that your mother has died.” Karofsky, deeply shaken by the unexpected news, managed to ask, “Did she struggle?” Karofsky’s important new book, DisElderly Conduct: The Flawed Business of Assisted Living and Hospice, does not mention the hospice nurse’s response to this question. But it does note that she called back a moment later to say: “I’m so sorry . . . . I called the wrong number. I’m at a different facility and I had the wrong file.” Karofsky’s mother, Lillian Deutsch, had not died at all. It was someone else’s mother. Apologies were made. This is just one of many stories Karofsky shares throughout the book about the final years of her mother’s life in Wisconsin. This particular anecdote strikes me as noteworthy not just as an example of the sort of awful things that can happen when facilities are understaffed and staff members are overworked, but also because Karofsky’s first reaction was to wonder whether she struggled.Editor's note: Though printed news typically lifts up the good, compassionate moments of hospice care, most all of us have experienced negative accounts--professionally and/or personally. While this book is sure to give significant insights, perhaps the most important lessons are waiting to be validated from your own family caregivers, employees, and volunteers. What stories are behind your lower-than-you-want CAHPS Hospice scores? Dig deeper. May we all listen, learn, and improve care.

Donate Life Ceremony celebrates organ donors and their families Vanderbilt University Medical Center; by Matt Batcheldor; 5/6/25 In addition to honoring organ donors and their families, the ceremony salutes hospital staff who care for donors and transplant recipients. Seventy-one individuals donated their organs at Vanderbilt University Medical Center in 2024, and they and their families were saluted on April 30 at the annual Donate Life Ceremony. “Those 71 donors resulted in 235 lives that were saved,” said C. Wright Pinson, MBA, MD, Deputy Chief Executive Officer and Chief Health System Officer for VUMC. ...  In addition to that, there were another 191 individuals who made the remarkable gift of tissue donation … which restored sight to the blind, enhanced the lives of burn victims, and gave mobility to those with bone and joint injuries.” ... The ceremony, held in the lobby of Langford Auditorium, was part of a national effort to raise awareness about the need for organ and tissue donors.

To the brink and back: How near-death experiences can change how people work The Conversation; by Adauri.AI; 5/5/25 What happens when someone comes close to death and then returns to everyday life, including work? For some, the experience can be transformative. ... Although near-death experiences (NDEs) have been studied since the 1970s, we know relatively little about how they affect people after the event. Research suggests people who have near-death experiences may feel increased empathy, spiritual growth, a sense of purpose and even change how they approach their jobs. Our recent study explored how near-death experiences impact people’s return to work. We interviewed 14 working adults who had a near-death experience as a result of medical crises such as a heart attack or accidents such as a car crash. What we found challenges conventional ideas about success, motivation and workplace culture.

University of Minnesota uses VR to study Alzheimer's, death Government Technology (GT) - Center for Digital Education; by Richard Chin; 5/2/25 At the University of Minnesota, medical school students have been using a virtual reality experience to understand the perspective of a woman dealing with the advanced stages of Alzheimer’s. ... When the University of Minnesota offered to let me experience what it’s like to die, naturally I said yes. Aren’t we all morbidly curious about the undiscovered country, as Hamlet put it, from which no traveler returns? Except this time, happily, I would get to return because it would be a virtual death, an experience in a VR studio that’s part of the university’s Health Sciences Library system. The dying experience is part of a series of VR simulations developed by a nine-year-old California-based company called Embodied Labs. They’ve created immersive, first-person experiences of what it’s like to have dementia, Alzheimer’s or Parkinson disease, vision or hearing loss, to be socially isolated or to experience aging as a LGBTQ person. And what it’s like to die.

Breaking with the status quo in end-of-life care through de-implementation Journal of Internal Medicine; by Chetna Malhotra and Ellie Bostwick Andres; 4/17/25... In the realm of serious illness, many patients undergo interventions that may marginally prolong life but often sacrifice quality of life and entail significant costs. These interventions, categorized as ‘low-value care’, often involve complex procedures, frequent hospitalizations and intense medical management, leading to considerable discomfort, reduced functional ability and overall decreased well-being and calling into question the efficiency and effectiveness of current end-of-life (EOL) care practices. ... How to conduct de-implementation in EOL contexts:

From stigma to support: Changing the cancer conversation Oncology Nursing Society (ONS); by Anne Snively, MBA, CAE; 4/29/25 Certain treatments (palliative care, opioids) and diagnoses (lung cancer) are more prone to association with cancer-related stigma. Nurses can play a vital role in reframing these thoughts and promoting empathy. ... Caner-related stigma has wide-reaching effects across the care continuum, including poorer patient outcomes. ...

Medical aid in dying in the state of Colorado: Perspectives, data, and lessons learned in the first years of a uniquely centralized programJournal of Palliative Medicine; Melanie Mandell, Katie Sue Van Valkenburg, Skye O’Neil, Genie E. Roosevelt, Kerri Mason; 4/25 In 2016, Colorado voters approved Proposition 106, “Access to Medical Aid in Dying,” which amended Colorado statutes to include the Colorado End-of-life Options Act. In 2018, Denver Health and Hospital Authority, an urban, county safety-net hospital established a program to provide comprehensive medical aid in dying care via a centralized clinic with a dedicated team including a medical director, social worker, and a network of volunteer consultants. As the program has developed and matured, it has grown exponentially. This is due to its ease of accessibility, statewide educational efforts, and the relatively low cost and need-based, free services it provides. In six and a half years, our centralized program assisted over 650 Colorado patients in their quest for accessing medical aid in dying care, providing a wide continuum of services from initial intake and counseling, visits, and financial aid to specific grief counseling for loved ones. We believe our centralized system may function as a model for other hospitals considering the need to improve aid in dying access and care.

5 risk factors at 50 can steal a decade of life Medscape; by Nadine Eckert; 4/17/25 Five classic risk factors for cardiovascular disease — high blood pressure, high cholesterol, obesity, diabetes, and smoking — at age 50 can reduce life expectancy by more than 10 years. This is the conclusion of an international study led by German researchers and presented at the 2025 American College of Cardiology Scientific Session. These five factors account for approximately 50% of the global burden of cardiovascular diseases. ... The findings, also published in The New England Journal of Medicine, show that lifestyle changes and risk management in middle age can make a significant difference. Lowering blood pressure and quitting smoking had the most significant impacts.

MedPAC identifies low rates of hospice use among kidney disease patients McKnights Home Care; by Adam Healy; 4/17/25 Patients with end-stage renal disease (ESRD) use hospice at far lower rates than patients with other conditions, according to the Medicare Payment Advisory Commission. In 2023, 31% of Medicare decedents with ESRD used hospice services, compared with 52% of all Medicare decedents. Hospice lifetime length of stay is also lower among decedents with ESRD, at a median of six days compared with 18 for all Medicare decedents, MedPAC commissioners said during their April meeting. ...

Integrating social determinants into palliative care Hospice News; by Holly Vossel; 4/16/25 Strong staff education and reimbursement are among the keys to successfully integrating social determinants of health within a palliative care program. Screening tools developed by the U.S. Centers for Medicare & Medicaid Services’ (CMS) include five areas of social determinants of health: food and housing insecurity, transportation needs, utility difficulties and interpersonal safety. Supplemental domains include financial stability, employment and family and social support, among others.