Literature Review

Medicare Advantage growth drives changes in post-acute care Managed Healthcare Executive; by Briana Contreras; 7/28/25 A new report released today by Trella Health revealed major shifts are underway in post-acute care as Medicare Advantage (MA) enrollment grows, care transitions evolve and providers navigate the challenges of value-based care. The Post-Acute Care Industry Trend Report looked at national and state-level trends in home health, hospice and skilled nursing using the latest Medicare claims and enrollment data. One of the most significant shifts is the continued rise of MA enrollment. The report shared that as of February 2025, more than half of Medicare beneficiaries (55.4%) are enrolled in MA plans, with 30 states reporting MA enrollment over 50%. This shift is changing how patients access care—more so in home health.

Why terminal cancer patients still receive aggressive treatment MedPageToday; by M. Bennet Broner; 7/31/25 Recently, researchers examined whether there had been any changes in the way terminal cancer patients died from 2014 to 2019, given the increased information available on hospice, palliative care, and advanced end-of-life planning (EOLP). They asked whether those who were terminal continued aggressive treatment until their demise. The authors anticipated a decrease in this, but found that the frequency of cancer patients who continued aggressive therapy had not declined. The study did not examine decision-making. Still, the researchers, based on other studies, theorized that the lack of change resulted from a confluence of physician and patient factors. ... [Physicians] might predict a more optimistic prognosis than justified, avoid discussing EOLP, support (over)intensive treatment, and/or overemphasize treatment effectiveness while minimizing its side effects. Oftentimes, given their statements, physicians will offer treatments they know to be of little value, believing that patients expect them to propose something rather than admit there was nothing realistic left to offer.Editor's Note: Pair this with our recent post, Doctors’ own end-of-life choices defy common medical practice.

After losing his wife, 92-year-old man turns grief into comfort for other Spectrum News 1 - Greece, NY; by Seth Voorhees; 8/4/25 The loss of a spouse can be devastating. A Rochester area man is turning his personal grief into comfort for others. The gesture has special meaning for families of people in hospice care. Howard Jones has always dabbled in art. At 92, the Kodak retiree has made painting his full-time job. ... [His wife through 68 years,] Estella spent her final weeks at Hildebrandt Hospice Care Center, where staff noticed Howard Jones would pass the time by painting rocks. Someone told him the story of the cardinal, and how some believe their appearance is a sign that a departed loved one is near.  ... [Now, he paints] “every day, eight hours a day,” said Jones. ... “It’s all a matter of getting the bird to look right,” he said. ... “My hope is always that when someone takes one of the stones out of the basket, they can feel the emotion that went into painting it,” said Jones. Since he began keeping track in February, Howard Jones says he’s painted over 500 cardinals. “And that's kept me going,” he said.Editor's Note: This demonstrates beautifully the "instrumental style of grieving" (identified by Ken Doka and Terry Martin in Grieving Beyond Gender) where men (and women) tend to grieve through actively doing something, in contrast to verbal and emotional expression. We described this more in our post, To Be or To Do? Women and Men's different styles of grieving.

Study reveals how medication side effects can lead to dangerous medication cycles in adults 65+ McKnights Long-Term Care News; by Donna Shryer; 7/31/25 When doctors treat drug side effects as new illnesses, older adults may be prescribed even more medications — a cycle known as a “prescribing cascade.” A new study says this prescribing cycle can increase the risk of harm. Guest Editor's Note, Drew Mihaylo, PharmD: Practicing clinical vigilance regarding medication utilization is essential at any stage of illness. Prescribing cascades are common, under-recognized and often harmful. Approaching the emotional topic of medication change must be done with compassion and sensitivity tied to patient specific goals of care. Creativity to this end has been a focus of mine for sometime now as a clinical pharmacist serving serious illness patients nationally.

Closing the gap: Addressing social determinants of health and racial disparities in hospice care Teleios Collaborative Network (TCN); by Alyson Cutshall; 8/4/25... While Americans’ health trajectories are inevitable at the time they become eligible for hospice services, SDOH (Social Determinants of Health) still play a major role for the patients and families our field is privileged to serve. ... [To] fully impact health equity, we must be cognizant of other examples of SDOH, such as racism and implicit bias.  Unfortunately, our collective field has not been as successful in addressing access to hospice care across differing racial and ethnic groups. ... Certainly, there are some pockets of improved access.  One Teleios member organization, Ancora Compassionate Care, recognized the alarming disparities within its community and set about to create change. Ancora leaders recognized that the Black community in their service area typically placed high trust in their religious leaders. To better understand their needs and preferences regarding end-of-life care and services, Ancora embarked on a "listening tour" to gather feedback and insights from these religious leaders. Using the wisdom imparted, Ancora adapted their care delivery to be more inclusive to the Black community.  As such, the organization is making incremental improvements in lessening the racial divide in access to hospice care.

The path to the future may be the un-obvious: Top news stories, July 2025 Teleios Collaborative Network (TCN); podcast by Chris Comeaux with Cordt Kassner; 8/6/25 The future of hospice care hangs in the balance as providers navigate a perfect storm of challenges and opportunities. From financial pressures closing hospice houses to unprecedented Medicare fraud schemes, from technological disruption to changing consumer expectations – the hospice field stands at a critical inflection point that demands both reflection and action. Join hosts Chris Comeaux and Cordt Kassner as they delve into the latest trends and challenges in Hospice and Palliative Care, discussing key trends, challenges, and innovations shaping the field. This episode covers a wide range of topics, including the impact of healthcare layoffs, disruptive innovations, and the importance of disaster preparedness. 

Hospice Honors 2025 - 2025 CAHPS Honors and Honors Elite Award winnersMatrixCare by ResMed; retrieved from the internet 7/29/25 214 CAHPS Honors and 53 Elite Award Winners are listed. These national recognitions are presented by HealthCare First, a part of MatrixCare. These awards are based on satisfaction scores from the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. "Honors Elite" status is awarded to those hospices that score above the national performance score on 100%, or all twenty four, of the evaluated questions. Editor's Note: We celebrate these significant achievements and thank you for the quality, expert care you provide each day! 

Andwell Health Partners CEO: Medicare Advantage becoming  ‘failed policy,’ jeopardizes home health accessHome Health Care News; by Morgan Gonzales; 7/21/25 The rise of Medicare Advantage (MA) has reshaped the home-based care landscape, but it’s putting home health providers in precarious positions while increasingly failing to deliver for beneficiaries. That’s according to the leader of Lewiston, Maine-based nonprofit provider Andwell Health Partners, which has significantly changed the way it cares for patients, including adjusting care plans, to adjust to increased penetration of MA. Andwell Health Partners’ CEO Ken Albert said MA is rapidly becoming a “failed policy,” on a recent episode of Home Health Care News’ Disrupt podcast. Formerly known as Androscoggin Home Healthcare + Hospice, Andwell Health Partners offers home health care, palliative care, hospice services and a slew of other services across Maine. Albert sat down with HHCN to discuss how the nonprofit will survive industry headwinds, the new service lines and innovations he has plotted for the organization, the future of Medicare Advantage and how nonprofit providers have to innovate to survive. 

How health care systems shape end-of-life care—A step toward transparencyJAMA Network Open; by Jacqueline M. Kruser, Gordon D. Rubenfeld; 7/25Our health care systems, in all their multifaceted complexities, are more influential in shaping the delivery of care than individual human effort or error. Influential system-level factors span many different domains: how we are paid, the buildings we work in, the technology around us, who and how many we have on the team caring for patients, our workload, and our local social networks of influence. One pragmatic first step in addressing the problem of invisible, inaccessible, and/or inflexible patterns of end-of-life care is to build awareness of and foster transparency about the current patterns and their default orientation. Building from this deeper understanding of how our everyday routines and practice patterns influence care, we can then take the bigger step of intentionally designing our routine clinical practice patterns to be systematic yet flexible in their support of patients with serious illnesses.

Simulating the overall hospital quality Star ratings with random measure weightsJAMA Network Open; by Benjamin D. Pollock, Daniel S. Ubl, Subashnie Devkaran, Sean C. Dowdy; 7/25We found that only 244 US hospitals achieved reliable excellence in hospital quality in 2024 when defined as 90th percentile performance or better in at least 50.0% of 100,000 simulations using random weights for each measure in the CMS Overall Star Ratings. Our analysis highlights that there is meaningful variation in hospital quality performance across the spectrum of quality measures, even among 5-star hospitals. Future efforts to assess this variation may allow for better identification of reliably excellent hospitals, which could in turn lead to solicitation of evidence regarding the processes or cultures that separate reliable excellence from inconsistent greatness in hospital quality.  

System wide goals of care implementation: A podcast with Ira Byock, Chris Dale, and Matt GonzalesGeriPal podcast; by Eric Widera, Alex Smith, Ira Byock, Chris Dale, Matt Gonzales; 7/24/25Most health care providers understand the importance of goals-of-care conversations in aligning treatment plans with patients’ goals, especially for those with serious medical problems. And yet, these discussions often either don’t happen or at least don’t get documented. How can we do better? In today’s podcast, we sit down with Ira Byock, Chris Dale, and Matthew Gonzales to discuss a multi-year healthcare system-wide goals of care implementation project within the Providence Health Care System. Spanning 51 hospitals, this initiative [found] an increase from 7% to 85% in goals of care conversation documentation for patients who were in an ICU for 5 or more days. How did they achieve this? Our guests will share insights into the project’s inception and the strategies that drove its success, including:

When grief involves trauma − a social worker explains how to support survivors of the recent floods and other devastating losses The Conversation; podcast by Gemma Ware with Dr. Liza Lane; 7/17/25 The July 4, 2025, floods in Kerr County, Texas, swept away children and entire families, leaving horror in their wake. Days later, flash floods struck Ruidoso, New Mexico, killing three people, including two young children. ... When death is sudden, violent, or when a body is never recovered, grief gets tangled up with trauma. In these situations, people don’t only grieve the death. They struggle with the terror of how it happened, the unanswered questions and the shock etched into their bodies. I’m a social work professor, grief researcher and the founder of The Young Widowhood Project, a research initiative aimed at expanding scholarship and public understanding of premature spousal loss. Both my personal loss and professional work have shown me how trauma changes the grieving process and what kind of support actually helps. To understand how trauma can complicate grief, it’s important to first understand how people typically respond to loss.

National Alliance for Care at Home hosts inaugural Financial Summit National Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 7/30/25 The National Alliance for Care at Home (the Alliance) successfully hosted its inaugural event, the 2025 Alliance Financial Summit, July 27-29 in Chicago, IL. The Summit brought together financial leaders from across the care at home community, with expert-led sessions, peer collaboration, and insights into market shifts and emerging technologies. More than 700 attendees and exhibitors participated in the comprehensive program, which featured keynote presentations, concurrent educational sessions, networking opportunities, awards, and celebration. ... “This first Alliance event exceeded our expectations, bringing together care at home leaders from across the nation to connect, learn, and recommit to our shared vision of an America where everyone has access to the highest quality, person-centered healthcare wherever they call home,” said Alliance CEO Dr. Steve Landers.