Literature Review

Characteristics of patients enrolled in hospice presenting to the emergency department American Journal of Emergency Medicine; by Kayla P Carpenter, Fernanda Bellolio, Cory Ingram, Aaron B Klassen, Sarayna S McGuire, Alisha A Morgan, Aidan F Mullan, Alexander D Ginsburg; 12/9/24, online ahead of print Emergency Departments (EDs) frequently care for patients with life-limiting illnesses, with nearly 1 in 5 patients enrolled in hospice presenting to an ED during their hospice enrollment. This study investigates the reasons patients enrolled in hospice seek care in the ED, the interventions they receive, and their outcomes. ... Patients enrolled in hospice most frequently presented to the ED for trauma [36%; with 15% for pain, 12% for catheter/tube malfunction]. Most received laboratory studies and imaging. Nearly half of patients were admitted to the hospital and short-term mortality was high, particularly for patients enrolled in hospice for needs for ED care? Ie.,

UConn John Dempsey Hospital joins National Age-Friendly Health System Movement UConn Today; by Jennifer Walker; 12/12/24 UConn John Dempsey Hospital was recently accepted for participation in the national Age-Friendly Healthy Systems Movement to improve health care for older adults. The Age-Friendly Health Systems Movement, sponsored by The John A. Hartford Foundation and the Institute for Healthcare Improvement in partnership with the American Hospital Association and the Catholic Health Association of the United States​, is a national collaboration of hospitals and health systems implementing a set of evidence-based interventions to make the care of all older adults equitable and age-friendly. This initiative addresses the reality that a growing proportion of the US population is elderly and has complex healthcare needs which challenge many institutions. This movement is built upon a framework of a set of four best practice interventions known as the 4Ms.

HSPN Staffing Summit: Leveraging technology for person-centered care Hospice News; by Sophie Knoelke; 12/9/24 This article is sponsored by CareXM. This article is based on a virtual discussion with Kathleen Benton, President and CEO of Hospice Savannah. ... Dr. Benton has a master’s degree in medical ethics and a doctorate in public health. She has offered and reviewed many publications relevant to the topics of palliative care, ethics, hospice, and communication. [Dr. Benton:] I was schooled in clinical ethics and really mediating ethical dilemmas in health care. Looking at, is this in the best interest of the patient? Are we truly following the patient’s wishes? Many of the dilemmas, I would say a good 90%, occur at the end of life. ... [At] the root of [really trending] cases was one missing element. That element was the lacking area of communication. What do I mean by that? I believe that health care does the worst job of probably all other areas of communicating with folks. We have really taken what it is to be human out of what it is to treat a patient and a person. [Click on the title's link to continue reading this insightful discussion.]

What adult children should know when discussing their parents’ end-of-life care StudyFinds; by StudyFindsStaff, reviewed by Christ Melore; 12/8/24 Talking about death can be difficult for anyone at any time. For adult children who need to know their parents’ final wishes, it can be excruciating. A new survey is revealing the stark disconnect between our beliefs and actions when it comes to end-of-life planning. While an overwhelming 90% of adults recognize the importance of these critical conversations, half have yet to take the first step with their closest loved ones. ... The numbers tell a revealing story. Twenty-six percent of respondents simply keep putting off the conversation, while 23% admit they don’t know how to approach the topic. Sixteen percent are outright scared to broach the subject, creating a wall of silence around a universal human experience. ... When people do open up, the conversations prove surprisingly rich and multifaceted.

Dr. James O’Connell on caring for the homeless in Boston Simmons University, Boston, MA; by Simmons University; 12/6/24 “A mile from here, people are experiencing the same health disparities as they have in Third World countries,” said Dr. James O’Connell, founder and president of Boston Health Care for the Homeless Program (BHCHP) and Assistant Professor of Medicine at Harvard Medical School. ... In 1985, O’Connell was the founding physician of a program to support the people experiencing homelessness in Boston. The program received funding through a four-year grant from the Robert Wood Johnson Foundation and the Pew Charitable Trust. ... [Story about getting a homeless man into hospice care at a nursing home.] When [O'Connell] questioned him about hospice, Santo shared his perspective. “He told me, ‘I appreciate all you’ve done, but I didn’t know anyone there. I don’t want to die there. I want to die with my friends.’” After that, they arranged end of life care for Santo at the shelter. “I had never thought to ask him what he wanted,” said O’Connell. “I have since learned that I have to listen to what people want.” 

'I've already had my miracle': 26-year-old Savannah mom enters hospice care with only weeks to live ABC WJCL 22 News, Savannah, GA; by Savannah Younger; 12/4/24 As the holiday season begins, Sara Long, a 26-year-old Savannah woman, is entering hospice care after a prolonged battle with kidney failure. Now the wife and mother is preparing to say her final goodbyes to family and friends. "I wanted to make sure that everything's kind of ready to go for when family visits and all that kind of stuff," Long said. "So, I just want to make things as easy as possible for everybody." Long has been told she has two to three weeks left to live and is now preparing her family for her passing. ... Their daughter, Riley, 4, is too young to understand what is happening, but Long is creating a hope chest so Riley can always remember her. "There are probably dozens, if not hundreds, of letters at this point, to open at different various points in her life. So, like her first day of school all through, or a graduate degree, potentially," Long said. "I feel like I've already had my miracle," Sara said. "I feel like Riley is my miracle. ..."Editor's note: See our "Today's Encouragement" for today, with a beautiful quote from Sara Long, in this article.

Bloom Healthcare CEO: Integrating palliative care into every decision Hospice News; by Jim Parker; 12/3/24 The house call provider Bloom Healthcare has leveraged its integrated palliative-primary care model to achieve substantial reductions in hospitalizations and health care costs. The U.S. Centers for Medicare & Medicaid Services recently recognized Bloom as a top performing High-Needs Accountable Care Organization under the agency’s Realizing Equity, Access and Community Health (ACO REACH) model. Through its ACO REACH program, Bloom reduced unplanned hospital readmissions by 25% and realized a gross cost savings rate of 24.6%. The company’s patients averaged 326.7 days at home during  2023. Bloom Healthcare cares for about 10,000 high-needs patients with a comprehensive primary care and care management model that incorporates palliative care. The company currently operates in Colorado and Texas. ... Palliative Care News sat down with Bloom CEO Dr. Thomas Lally to discuss the strategies the company used to garner these results and how palliative care factored in. [Click on the title's link to continue reading.]

Ensuring equity in access to palliative care AJMC - The American Journal of Managed Care; by Laura Joszt, MA and Alexandra Gerlach; 11/28/24 Palliative care provides high-quality care that can provide relief from the symptoms of a serious illness, but just as there are issues to accessing cancer treatments, there are barriers to palliative care, as well as racial disparities in access, explained Nadine J. Barrett, PhD, MA, MS, FACCC, senior associate dean for community engagement and equity in research, Wake Forest University School of Medicine and Atrium Health, and current president of the Association of Cancer Care Centers (ACCC). ... There are misconceptions about what palliative care is that may limit the utilization of it, but also existing disparities mean fewer Black and Hispanic individuals access these services compared with their White counterparts.

Palliative care bypasses Black heart disease patients The St. Louis American; by Alvin A. Reid; 11/30/24 A study by Saint Louis University researchers paints a grim picture for many heart failure patients in America – and the outlook is worse for African Americans. The study, published in the Journal of the American Heart Association, found that only one in eight patients with heart failure nationwide receive palliative care consultations within five years of diagnosis. Alarmingly, Black people were 15% less likely to receive palliative care compared to white patients with similar heart health illness. Other recent respective studies illustrate the higher risk and mortality rates for cardiovascular disease in the Black population – further demonstrating that the missing palliative care options have a greater negative impact on African American health. New statistics from a medical team at EHproject show African American women are at a greater risk for cardiovascular disease than their white counterparts. It found that 47.3% of Black women have heart disease. If they do not have it currently, they are 2.4 times more likely to develop heart disease. ... A March 2023 study published in JAMA Cardiology showed that Black men remain at the highest risk of dying from cardiovascular disease. ... 

New HFSA Consensus Statement provides practical guide for implementing palliative care with heart failure patients PR Newswire; by Heart Failure Society of America; 11/26/24 Patients with heart failure (HF) suffer from compromised quality of life, high mortality, and complex medical decision-making. Palliative care is an essential part of a comprehensive HF care plan. Integration of Palliative Care into Heart Failure Care: Consensus-Based Recommendations from the Heart Failure Society of America (HFSA), published today in the Journal of Cardiac Failure (JCF), is a practical guide for implementing palliative care as a component of overall HF care. It has been shown that palliative care interventions improve disease-specific quality of life, symptom control, and caregiver burden among patients with HF. Authors of the statement are indicating that HF clinicians should be skilled in providing primary palliative care with competence in basic domains including the management of physical and psychosocial symptoms and serious illness communication.

Disclosure practices in Muslim patients and the impact on end-of-life care: A narrative review American Journal of Hospice and Palliative Care; by Mona Tereen; 11/26/24 ... Non-disclosure practices hold significant weight in end-of-life care for Muslim communities, where cultural and religious beliefs are deeply intertwined with healthcare decision-making. This narrative review explores the complexities of medical decision-making and disclosure practices among terminally ill Muslim patients, examining how these factors shape palliative care delivery. Conclusion: Non-disclosure practices present significant barriers to effective palliative care in Muslim communities. To improve care outcomes, culturally competent communication strategies and family-centered decision-making models are crucial.

Early hospice care has transformative impact McKnights Senior Living; guest column by Aaron Housh, CEO of Good Samaritan Hospice in Roanoke and Christiansburg, VA; 11/25/24 Hospice care is more than a medical service — it’s a lifeline of compassion, connection and support during one of life’s most vulnerable moments. For more than 20 years, I’ve witnessed the profound impact hospice can have, not just on residents and patients but on the families who love and care for them. But this impact is magnified when hospice care is introduced early. ... One of the greatest gifts hospice provides is time — time to prepare, time to connect and time to say goodbye. A friend once shared how hospice changed her family’s experience with her mother’s death. The nurse spent time explaining what to expect, answering questions and normalizing the changes they were seeing. That preparation eliminated panic, allowing the family to focus on being present. Her mother passed with dignity, surrounded by love and understanding. This story illustrates what I’ve seen time and again: families who enter hospice early have the opportunity to build trust with their care team, process emotions and fully use the services available to them. Those families are better equipped to navigate the physical and emotional challenges of end-of-life care, creating space for meaningful moments and lasting memories.