Literature Review

Homecare owner allegedly withholds $86k in wages HomeCare, Indianapolis, IN; 11/11/24 The U.S. Department of Labor (DOL) has alleged that home health care company owner Hahn March violated federal wage laws and withheld $86,000 in wages by using improper pay practices at her two Indianapolis, Indiana, companies: Signal Health Group Inc. and SHG Employee Leasing Company. In 2018, federal investigators cited March for not paying overtime wages to employees at her then-owned company, Aging and Disabled Home Healthcare. ... The complaint was filed following an investigation by the DOL Wage and Hour Division, which discovered March and Nancy Stanley, the chief financial officer of both companies, used an artificial regular rate pay scheme to lower hourly pay rates and, in turn, shortchanged employees $86,427 in overtime wages. ... The DOL is seeking $172,854—including $86,427 in back wages and an equal amount in liquated damages—for 43 current and former employees. ... “Employees who work in home health care—one of our nation’s lowest-paying professions—provide necessary daily and hospice care that allow individuals to remain in their homes and aid them in navigating their basic needs, providing dignity and comfort to clients and their families,” said Aaron Loomis, Wage and Hour Division district director.

National Partnership for Healthcare and Hospice Innovation, and American Cancer Society unveil Advanced Cancer Guide to Support Patients & Families Facing Terminal Cancer National Partnership for Healthcare and Hospice Innovation (NPHI), Washington, DC; 11/13/24 Today, the National Partnership for Healthcare and Hospice Innovation (NPHI), the national voice for nonprofit serious illness care providers, proudly introduces the Advanced Cancer Care Patient & Caregiver Guide, developed in collaboration with the American Cancer Society. This essential resource is designed to assist individuals living with cancer and their caregivers by providing critical information that enables them to receive care in the comfort of their own homes. ... This comprehensive guide aims to minimize hospital and emergency room visits, easing stress for patients, families, and medical facilities alike. Drawing on the expertise of over 100 serious illness care providers and the American Cancer Society, it delivers practical, reliable support for those navigating cancer care at home. Editor's note: The National Partnership for Healthcare and Hospice Innovation (NPHI) is a sponsor for our newsletter.

Social determinants of health and US health care expenditures by insurerJAMA Network Open; Giridhar Mohan, MPH; Darrell J. Gaskin, PhD, MS; 10/24US health expenditures have been growing at an unsustainable rate, while health inequities and poor outcomes persist. In this cross-sectional study of 14,918 insured adults, individual-level SDOH [social determinants of health] were significantly associated with US health care expenditures by Medicare, Medicaid, and private insurers. These findings may inform health insurers and policymakers to incorporate SDOH in their decision-making practices to identify and control health care expenditures, advancing health equity.

Most heart failure patients miss out on guideline-recommended palliative care Cardiovascular Business; by Dave Fornell; 11/6/24 Over the past decade, the American Heart Association (AHA) and European Society of Cardiology have recommended integrating palliative care into heart failure management. Despite these recommendations, the use of palliative care for heart failure remains low in the United States. Racial and geographic variations in access and use of palliative care are also pronounced, highlighting health disparities. These were the findings of a recent study in the Journal of the American Heart Association. Researchers at Saint Louis University led the study and said only one in eight patients with heart failure in the United States receive palliative care consultations within five years of diagnosis. Their study highlights the alarmingly low uptake of palliative care among adults with heart failure in the U.S., especially compared to patients with cancers that have the same mortality rates. The study also pointed out significant racial and geographic disparities. Black patients were 15% less likely to receive palliative care compared to their white counterparts. They said this disparity is particularly concerning given the higher cardiovascular risk and mortality rates in the Black population.

Clinician staffing and quality of care in US health centersJAMA Network Open; Q. Wilton Sun, BA; Howard P. Forman, MD, MBA; Logan Stern, DNP, APRN; Benjamin J. Oldfield, MD, MHS; 10/24In this cross-sectional study of 791 US health centers, 5 distinct clinician staffing ratio models were identified, and models emphasizing physicians, advanced practice registered nurses, and physician associates were positively associated with distinct sets of individual quality metrics. In this cross-sectional study of health centers, physician FTE [full time equivalent] ratio was associated with higher performance in cancer screening, infant vaccinations, and HIV testing; APRN FTE ratio was associated with higher performance in preventative health assessments; and PA FTE ratio was associated with higher performance in infant vaccination.

Older Americans living alone often rely on neighbors or others willing to help California Healthline; by Judith Graham; 11/12/24Donald Hammen, 80, and his longtime next-door neighbor in south Minneapolis, Julie McMahon, have an understanding. Every morning, she checks to see whether he’s raised the blinds in his dining room window. If not, she’ll call Hammen or let herself into his house to see what’s going on. Should McMahon find Hammen in a bad way, she plans to contact his sister-in-law, who lives in a suburb of Des Moines. That’s his closest relative. Hammen never married or had children, and his younger brother died in 2022. Although Hammen lives alone, a web of relationships binds him to his city and his community — neighbors, friends, former co-workers, fellow volunteers with an advocacy group for seniors, and fellow members of a group of solo agers. ... American society rests on an assumption that families take care of their own. But 15 million Americans 50 and older didn’t have any close family — spouses, partners, or children — in 2015, the latest year for which reliable estimates are available. Most lived alone. By 2060, that number is expected to swell to 21 million. ... [Click on the title's link to continue reading.]Editor's note: This important article references (1) "a noteworthy study published by researchers at Emory University" titled "Solo but not alone," which we will include in a Saturday research issue and (2) an AAPR survey that gives the name "solo agers." I give a shout-out to the visionary "Living Alone Program" back in 1993 at Hospice of Louisville (now Hosparus), and to all hospices who deliver creative, quality care to persons who live alone.

Solo but not alone: An examination of social and help networks among community-dwelling older adults without close familyJournal of Applied Gerontology (J Appl Gerontol); by Jane Lowers, Duzhi Zhao, Evan Bollens-Lund, Dio Kavalieratos, Katherine A Ornstein; 11/31/2022... Nearly one in four adults is at high risk for aging without a spouse or children ... Previous descriptions of adults aging solo have focused on social isolation (Chamberlain et al., 2018; Roofeh et al., 2020), yet diverse, non-kin social networks can provide robust emotional and instrumental (task-oriented) support and such networks are becoming more common over time (Suanet & Antonucci, 2016; Verdery et al., 2019), although the type and intensity of support may vary by the type of relationship (e.g., kin vs non-kin) and factors including frequency of interaction (Wellman 1990). ... Therefore, as a first step, we sought to define the population of adults aging solo and compare its social networks and sources of help to adults with close family nearby. Editor's note: Though this article is from 2022, we are posting it due to our post on 11/13/24, Older Americans living alone often rely on neighbors or others willing to help, and our readers' frequent "most read" articles about seniors' challenges with isolation, depression, and caregiving challenges. 

Hospice organizations honor veterans for Veterans Day

Pennsylvania LPNs will now be able to make death pronouncements Tri-State Alert; 11/4/24 A bill sponsored by Sen. Lynda Schlegel Culver (R-27) was signed into law this week to enable licensed practical nurses (LPNs) working in a hospice setting to make death pronouncements. “I am grateful for the governor’s support of this important legislation,” Culver said. “LPNs are with patients and their families until the moment of death, providing essential care during emotional times. Allowing LPNs to make death pronouncements, which was previously only a function of doctors, RNs, physician assistants, and coroners, can alleviate wait times that grieving families often experience.” The bill was amended in the House of Representatives to also provide needed clarification on the waiver of birth and death certificate fees for members of the armed services, veterans, and their families. The law now outlines specifically whose documents qualify for the waiver, as well as applicants and scenarios for which the fee may be waived. 

Asian American diversity and representation in the health care workforce, 2007 to 2022JAMA Network Open; Michelle Ko, MD, PhD; Kevin Dinh, MS; Sarah Iv, BS; Monica Hahn, MD; 10/24In this serial cross-sectional study of American Community Survey 1-year estimates from 2007 to 2022, Filipinx Americans had consistently high representation among registered nurses and nursing assistants; Indian, Pakistani, and Chinese Americans predominated among physicians, whereas Hmong and Cambodian American representation in medicine remained substantially below general population representation. Bangladeshi and Chinese American representation grew among home health aides over the study period. These findings suggest that aggregation of Asian American subgroups into a single racialized group erases substantial inequities in health workforce diversity.

Morphomics, survival, and metabolites in patients with metastatic pancreatic cancerJAMA Network Open; Valerie Gunchick, MS; Edward Brown, MS; Juan Liu, PhD; Jason W. Locasale, PhD; Philip A. Philip, MD, PhD; Stewart C. Wang, MD, PhD; Grace L. Su, MD; Vaibhav Sahai, MBBS, MS; 10/24In this large cohort study, we observed no association of BMI [body mass index] with survival for patients with metastatic PDA [pancreatic ductal adenocarcinoma]. However, longer survival was associated with more subcutaneous fat and a higher muscle-to-fascia ratio, whereas shorter survival was associated with more dense visceral fat. In addition, we observed large-magnitude associations of subcutaneous fat and muscle-to-fascia ratio with several metabolites, which provide key biological insight.

Emergency department visits among patients with dementia before and after diagnosisJAMA Network Open; Cameron J. Gettel, MD, MHS; Yuxiao Song, MS; Craig Rothenberg, MPH; Courtney Kitchen, BA; Andrea Gilmore-Bykovskyi, PhD, RN; Terri R. Fried, MD; Abraham A. Brody, PhD, RN; Stephanie Nothelle, MD; Jennifer L. Wolff, PhD; Arjun K. Venkatesh, MD, MBA, MHS; 10/24Emergency department (ED) visits among persons living with dementia represent a substantial health care challenge, often necessitating targeted interventions to optimize care and support. We assessed changes in ED use before and after incident dementia diagnosis among Medicare beneficiaries aged 65 years and older. Within the entirety of the 12-month period assessed, having a diagnosis of dementia was associated with a 40% increase in the likelihood of having an ED visit. The observed changes in ED use, with peaks before and after dementia diagnosis, suggest that the diagnostic process may precipitate acute health care crises and increased health care–seeking behavior among individuals with dementia and their caregivers.

Person-centered care planning for people living with or at risk for multiple chronic conditionsJAMA Network Open; Brittany N. Watson, MD, MPH; Lilly Estenson, MSW; Aimee R. Eden, PhD, MPH; Maya T. Gerstein, DrPH; Maria Torroella Carney, MD; Vonetta M. Dotson, PhD; Trisha Milnes, AuD, MHA; Arlene S. Bierman, MD, MS; 10/24This qualitative study identified 9 themes for strategies for, as well as facilitators and barriers to implementation of PCCP [person-centered care planning]: (1) suboptimal quality of care; (2) person-centered, goal-concordant care; (3) multidisciplinary team–based care and care coordination; (4) prevention across the life course; (5) digital health solutions; (6) workflow; (7) education and self-management support; (8) payment; and (9) achieving community, health system, and payer goals. These themes identified reforms needed and components of care delivery models to support PCCP.