Literature Review

Labor activity in long-term care may be poised for ‘enormous’ growth in 2024McKnight’s Long Term Care NewsDecember 21, 2023Heightened union activity frequently made headlines this year, including among healthcare workers who loudly raised concerns about pay and staffing. Multiple factors make it likely that the trend of rising labor activity in long-term care will continue in 2024, experts say. 

The Top 10 Home Health Care News Stories Of 2023Home Health Care NewsDecember 20, 2023In the first year that truly felt “post-COVID,” home-based care providers did not see a shortage of challenges. Instead, in 2023, home health providers saw another year defined by payment struggles, with both the Centers for Medicare & Medicaid Services and Medicare Advantage plans.  ... Reflect back on this year in home-based care by revisiting 10 of HHCN’s most widely read stories.

Caring for Dementia during the holidaysValley Times News (Lanett, AL)December 20, 2023The holidays can be a stressful time for everyone, but they pose a unique challenge for senior citizens, individuals with disabilities, or those living with dementia and their caregivers. Dr. Joe Downs, from the Chattahoochee Hospice, said checking on caregivers of people with dementia is important all year around, but it can be especially important during the holidays. 

A Lukewarm Home Health, Hospice Dealmaking Year Comes To A CloseHome Health Care NewsDecember 19, 2023Following consecutive record years for health care transactions, 2023 was a comparatively lukewarm time for home health and hospice dealmaking activity. That’s according to a recent report from PwC. Specifically, there were 95 home health and hospice deals in the 12 months examined by PwC, which ended on Nov. 15., compared to 114 during the same period last year. The deals were worth $4.7 billion. ... PwC experts believe that M&A will likely be a key growth and profit driver next year.

The Language of Hospice Can Help Us Get Better at Discussing DeathTIMEDecember 18, 2023Just because death is inevitable doesn’t make it easy or natural to talk about. In a new study, researchers wondered if hospice workers—experts in end-of-life care—had lessons to teach the rest of us when it came to speaking with patients and families about death. Daniel Menchik, an associate professor of sociology at the University of Arizona who studies the use of language in different fields of medicine, spent eight months sitting in on team meetings at a hospice care facility that were also open to patients’ families. ... In the study, Menchik noticed that hospice workers used three different types of verbs in meetings with family members: predictive, subjunctive, and imperative. Predictive verbs are used to assert things about the future and include words like “will” and “going to.” Imperative verbs carry a similar firmness, but include a call to action; the most common one Menchik encounters in medical settings is “should.” Subjunctive verbs convey some sort of personal stance when talking about the future. “Think,” “feel,” “want,” and many other expressive phrases fall in this category. When a family starts hospice care, “their capabilities to engage in intense conversations [about death] are usually pretty limited,” Menchik says. But he believes that hospice workers help bridge that gap by minimizing their use of imperative verbs. In meetings he observed, imperative verbs made up just 17% of the verb phrases used by hospice professionals. That’s fairly uncommon in medicine. Editor's Note: Use this article to examine the language used in your team meetings; to strengthen your orientation of employees from non-hospice settings; to engage your admissions nurses in a lively dialogue about its applicability to their experiences with patients and families.

Washington Post Reports Highlight Assisted Living Resident Elopements and Staffing Problems, Industry Pushes BackSenior Housing NewsDecember 17, 2023A new Washington Post investigation has detailed dozens of incidents where senior living residents have wandered away and died as well as “bare-bones” staffing levels at communities across the country. In one article published over the weekend, the Post examined thousands of cases since 2018 where senior living residents wandered away from their communities, resulting in nearly 100 deaths in that time. ... The articles underscore the challenges senior living operators will surely have in the coming years, in terms of both staffing and managing communities and maintaining positive perceptions among the public. 

Palliative-Behavioral Health Collaborations Benefit Patients with Serious Mental IllnessesPalliative Care NewsDecember 15, 2023Palliative care providers have opportunities to bridge gaps of unmet needs among patients who have serious mental illnesses and their families. ... Building up community-based palliative and mental health care collaborations will be crucial to supporting a growing population of seniors with SMIs with complex needs, he [Dr. Andrew Esch, palliative care physician and senior education advisor at the Center to Advance Palliative Care] said. ... Some of the most common SMIs among seniors include bipolar disorder, schizophrenia, borderline personality disorder and post traumatic stress and major depression, among others.

‘Tougher Every Day’—Nursing Home Operators, CCRCs Weigh in on Future of Skilled NursingSkilled Nursing NewsDecember 14, 2023Operating a skilled nursing facility today is considered a “tough business” with regulations and reimbursement woes making the space “tougher every day.” Other operators say they regularly budget a loss for skilled nursing services, and if it weren’t for other lines of business, skilled nursing would be unsustainable. 

Proportion of hospice users declines while industry undergoes shift, NHPCO report findsMcKnight’s Home Care DailyDecember 14, 2023The proportion of Medicare beneficiaries who died on hospice continued to decline in 2021, according to the National Hospice and Palliative Care Organization’s 2023 Fact and Figures report. ... Notably, the number of hospice users rose by thousands since 2019, but this growth was unable to outpace the proportion of Medicare beneficiaries who died without receiving any hospice care. 

Telehealth use among seniors back up to pandemic-era highs, one company claimsMcKnight’s Senior LivingDecember 13, 2023Nearly all seniors in the US, an astonishing 97%, had at least one telehealth appointment this year, a new survey indicates. The data, which comes from remote platform operator Independa, indicates that telehealth usage among seniors has grown 20% over the past three years, nearly back up to the pandemic-era peak, when in-person options were not available. 

2023 NHPCO Facts and Figures Report Now AvailableNews ReleaseDecember 13, 2023Alexandria, VA—The National Hospice and Palliative Care Organization has published its 2023 edition of Facts and Figures, an annual report on key data points related to the delivery of hospice care, including information on patient characteristics, location and level of care, Medicare hospice spending, and hospice providers. NHPCO Facts and Figures is the leading resource for hospice providers and others interested in understanding the work of the community. Editor's Note: Click here to access NHPCO's Report

Study uncovers racial inequalities in hospice utilization, length of stayMcKnight’s Home Care DailyDecember 12, 2023Blacks and Hispanics are less likely to use hospice services, and those who do often have shorter lengths of stay than white patients, according to a new study published in JAMA Health Forum. ... Minority patients also generally experienced shorter hospice lengths of stay. Hispanic patients in particular were more than twice as likely to stay in hospice care for seven days or less, compared to the average white Medicaid beneficiary. Still, short length of stay was relatively common across the board at about 40%, which suggests “room for improvement in referring all Medicaid recipients to hospice earlier in the course of terminal illness,” the study’s authors wrote. As to possible reasons for these disparities, the researchers noted that language barriers, mistrust of hospice programs or cultural differences might be at play. But also, the inequity might also reflect “potential racial biases that affect who a physician is more likely to refer to hospice,” according to the study. Specific, targeted efforts to encourage hospice services for Medicaid and dual-eligible beneficiaries who show low rates of utilization may help to overcome these disparities.

MedPAC draws fire with draft recommendations for massive home health cut, hospice rate freezeMcKnight’s Home Care DailyDecember 12, 2023The Medicare Payment Advisory Commission offered initial recommendations for Congress to cut home health reimbursement by 7% and pause hospice payment updates in 2025. “The 2022 [home health] margins remain above 20%, higher than the long-run average of 16.8% since 2001,” Evan Christman, senior analyst at MedPAC, said during last Friday’s public meeting, according to a transcript. “Overall, these margins indicate that Medicare fee-for-service continues to pay well in excess of cost.” Part of the reason home health agencies reportedly saw margins of 22.2%, on average, according to Christman, is a decline in the number of visits per 30-day period. Since the implementation of the Patient-Driven Groupings Model in 2020, these visits have declined more than 15%; between 2021 and 2022, visits per 30 days declined 3.5%. Home health advocates were quick to dispute MedPAC’s claims. “There are many shortfalls in MedPAC’s home health margins report—starting with the fact that MedPAC’s analysis only captures a declining fraction of the Medicare home health population, ignoring that overall margins are low,” Joanne Cunningham, chief executive officer of the Partnership for Quality Home Healthcare, said in a statement. ... The Partnership and National Association for Home Care & Hospice cited poor methodology and data in the recent home health final rule, which contained a Medicare cut related to PDGM. MedPAC also recommended that Congress eliminate any payment updates for hospice providers in 2025.