Literature Review

House call: Hospital care at home is about to explode in New Jersey mycentraljersey; by Scott Fallon; 9/11/24 Delia Halpin was being treated for a lung infection at Hackensack University Medical Center over three days in July when doctors came to her room with a suggestion: You can go home if you’d like. Halpin, 80, wasn’t being discharged. She was returning to her Maywood house with a load of medical equipment, a tablet to let her keep in touch with doctors, and a team of nurses who would visit every day until she recovered. “No one wants to be in the hospital,” she said. “It was great to be home, be around family, be around the things you’re comfortable with.” Halpin is among the first wave of patients who received care under Hackensack’s new “Hospital from Home” program — but she is far from the last. ...

Why so many patients are confused about CPR and do-not-resuscitate orders STAT; by Lindsey Ulin; 9/11/24 Inherently difficult conversations are made more so by a lack of physician training. When a patient is admitted to the hospital in the U.S., there’s a standard question physicians like me are supposed to ask: “If your heart stops beating, do you want us to do CPR?” On the surface, this may seem like a mechanic asking a customer, “If your car stalls, do you want us to jumpstart the engine?” Who would say no to this, especially in a hospital? The problem is that this exchange, which we call asking about “code status” in medicine, centers around a closed-ended question. Talking to a patient about their preferences for cardiac resuscitation, intubation, and/or other life-sustaining treatments needs to be a complete, often lengthy discussion, not just a box to check. ...

Rita and Alex Hillman Foundation announces $500,000 in funding for nine projects to improve serious illness and end of life care Globe Newswire; by Rita & Alex Hillman Foundation; 9/10/24 The Rita and Alex Hillman Foundation ... announced nine grants to support innovative, early-stage interventions that address the serious illness and end of life needs of marginalized populations. The $500,000 in funding, part of a collaborative effort with The Arthur Vining Davis Foundations, will advance nursing-driven initiatives that improve care for diverse populations and expand access to high-quality end of life services. ... This year’s grants demonstrate a commitment to the design, development, and delivery of better and more equitable care. The 2024 HSEI grant recipients are:

National Health Statistics Reports: Overview of Post-acute and Long-term Care Providers  and Services Users in the United States, 2020 CDC U.S. Centers for Disease Control and Prevention; by Jessica P. Lendon, Ph.D., Christine Caffrey, Ph.D., Amanuel Melekin, Ph.D., Priyanka Singh, M.P.H., Zhaohui Lu, M.S., and Manisha Sengupta, Ph.D; dated 8/27/24, released 9/7/24 Objective: This report presents national results from the National Post-acute and Long-term Care Study to describe providers and services users in seven major settings of paid, regulated post-acute and long-term care services in the United States. Methods - Data Sources: Data include about 11,400 home health agencies, 5,200 hospices, 1,200 inpatient rehabilitation facilities, 350 long-term care hospitals, and 15,300 nursing homes. Results:

Ohio hospital closes amid financial challengesBecker's Hospital CFO Report; by Madeline Ashley; 9/4/24Hicksville, Ohio-based Community Memorial Hospital permanently closed its doors Aug. 31 after temporarily shutting down in May due to financial challenges, Bill Cherry, former CEO of Community Memorial Hospital, confirmed with Becker's. "The decision to close Community Memorial Hospital follows thorough efforts to find a viable path to continue operations," Mr. Cherry said in a Sept. 4 statement shared with Becker's. "Unfortunately, despite all our efforts made, CMH has not been able to identify a sustainable solution. We understand the profound impact this closure will have on the community and we extend our deepest gratitude to the residents of Northwest Ohio and Northeast Indiana for their unwavering support and trust over the years."

1,100 Providence hospital workers end strike: 7 things to knowBecker's Hospital Review; by Kelly Gooch; 8/29/24About 1,100 SEIU Healthcare 1199NW-represented workers have ended their weeklong strike at Richland, Wash.-based Kadlec Regional Medical Center and its Kennewick ER, as contract negotiations continue. [Click on article link above for] seven things to know about the strike and negotiations.Publisher's note: We're including this story because 1) about half of palliative care is provided in hospital settings, 2) hospital referrals are important for hospices, and 3) changes in hospital workforce may be opportunities for hospital-based palliative care and community-based hospice providers.

Site-of-Care shifts and payments—A viable strategy to control health care costs?JAMA Open Network; Lee A. Fleisher, MD, ML; Sheila P. Burke, RN, MPA; 8/24The authors sought to determine what proportion of care was currently being performed in hospital-based settings and investigated how much could be shifted to nonhospital settings today and 7 to 10 years in the future with technological advances. They found that the major barriers to site-of-care shifts were economic arrangements, ownership models, and perceived loss of continuity of care at alternative sites. These results affirm their view that to reduce health care spending and protect Medicare trust funds, it will be critical to develop financial incentives and, just as importantly, eliminate financial disincentives to drive care to the safest and lowest-cost site of service.

Health systems brace for the 'silver tsunami'Becker's Hospital Review; by Laura Dyrda; 8/23/24Around 10,000 Americans turn 65 years old every day, gaining access to Medicare benefits. The number of Medicare beneficiaries is expected to continue growing in the next five years, and health systems are making changes to keep up. In 2020, around 73 million Baby Boomers were eligible for Medicare benefits, and by 2030 all Baby Boomers will be Medicare-eligible, according to the Census Bureau. Advances in medicine and healthy lifestyle mean people are living longer and demanding more from their care. "In the next five years, the most significant disruptor to healthcare will be the capacity challenges associated with the 'silver tsunami' of baby boomers hitting the age of healthcare consumption," said Jonathan D. Washko, MBA, FACPE, NRP, AEMD, Assistant Vice President, CEMS Operations, Northwell Health; Assistant Professor, Department of Emergency Medicine, Pre-hospital and Disaster Medicine, Zucker School of Medicine at Hofstra, Northwell Health. "In this environment, coupled with lowering revenues, staffing shortages and higher expenses, healthcare is being forced from an abundance mindset to one of scarcity."

Between the hospital and the street: Addressing a crucial gap in care healthleaders.com; by Eric Wisklund; 8/23/24 A unique program in Salt Lake City is managing care for underserved patients who live on the street or in an unsafe location, and helping hospitals reduce ED crowding, improve care coordination and reduce costs in the process. The INN Between is a nine-year-old program that began as a 16-bed Catholic convent and is now an 80-bed “assisted living facility” of sorts, offering everything from hospice care to rehabilitation and care management services. The organization addresses a significant care gap for health systems and hospitals who see these patients in their Emergency Departments and ICUs—and who often discharge them to an uncertain care landscape. ... The INN Between, which operates year-to-year on a budget of $1.6 million (recently cut down from $2 million), exists on a mishmash of charitable donations, grants, and the occasional federal or state subsidy. Editor's Note: Pair this compassionate solution with the scathing article about hospice fraud and abuse of homeless persons, Fraudulent hospices reportedly target homeless people, methadone patients to pad census, by Jim Parker at Hospice News.

My Dad had an Advance Directive. He still had to fight to die Newsweek - My Turn; by Maggie Schneider Huston; 8/26/24 My mom  died peacefully. My dad died 72 days later, angry at the doctors for ignoring his wishes. ... Dad had heart surgery on December 20, 2023. An hour after the surgery ended, his vital systems started shutting down. A cascade of interventions, one after another, kept him alive. Four days later, he said: "Put me on hospice." The doctor dismissed this request, rolling his eyes and saying: "Everyone on a ventilator says that." On Christmas Day, my father asked for hospice again. He was in pain. He knew his recovery would be long and ultimately futile. He would never have an acceptable quality of life again. ... Dad's care team insisted palliative care was the same as hospice care, but he knew the difference. He wanted hospice care. Finally, they reluctantly agreed and called for a social worker to make arrangements. It wasn't necessary. Once they removed his treatment and relieved his pain, he died five hours later. ... Editor's Note: This article is not about Medical Aid in Dying (MAiD). It is about honoring Advance Directives, person-centered care with communications and actions related to "palliative" vs. "hospice" care.

Capitol Notebook: New study spotlights Iowa health care landscape TheGazette; by The Gazette-Lee Des Moines Bureau; 8/22/24 More Iowa health care facilities have closed than opened since 2008, and more Iowa hospitals are operating at a loss as workforce shortages and costs rise. ... Key findings of the report include: 

Palliative care is a viable option for frail elderly patients with neurocognitive disorders admitted for hip fractures BMC Musculoskeletal Disorders; by Justine Boulet, Etienne L Belzile, Norbert Dion, Chantal Morency, Mélanie Bérubé, Alexandra Tremblay, Stéphane Pelet; 8/10/24 Most patients presenting with a hip fracture regardless of their comorbidities are surgically treated. A growing body of research states that a certain type of elderly patient could benefit more from a palliative approach. ... The presence of [a nuerocognitive disorder] NCD and diminished prefracture autonomy strongly support counseling for palliative care. The high rate of complications when surgery is proposed for frail patients with multiple comorbidities suggests that the concept of palliative surgery needs to be revisited. 

Deals reached to keep some Steward hospitals in Massachusetts open, Gov. Healey says Boston 25 News; by Colin A. Young, State House News Service; 8/16/24 Gov. Maura Healey announced late Friday morning that Massachusetts will take St. Elizabeth’s Hospital in Brighton by eminent domain in order to keep the hospital open while it transitions to a new owner. ... The governor said deals in principle have been struck to transition operations at the other four for-sale Steward Health Care hospitals – Saint Anne’s Hospital in Fall River, Good Samaritan Medical Center in Brockton, the Holy Family Hospitals in Methuen and Haverhill and Morton Hospital in Taunton – to new operators. ...