Literature Review

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."

Improving post-hospital care of older cancer patients Cancer Health; by University of Colorado Cancer Center and Greg Glasgow; 8/26/24 A few years ago, University of Colorado Cancer Center member and hospitalist Sarguni Singh, MD, began to notice a troubling trend: Older adults with cancer who were leaving the hospital for skilled nursing facilities after treatment were being readmitted to the hospital or having worse outcomes while in rehabilitation. ... Singh knew of an intervention called Assessing and Listening to Individual Goals and Needs (ALIGN) — a palliative care social worker-led protocol aimed at improving quality of life, aligning goals of care, and providing support to patients and caregivers — and she began using it for cancer care. ... The results were overwhelmingly positive, and patients and caregivers told us, ‘This was so helpful,’” says Singh, associate professor of hospital medicine in the CU School of Medicine.

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. ...

34 hospitals, health systems raising workers' pay Becker's Hospital Review; by Kelly Gooch; 8/15/24 The following hospitals and health systems have announced or shared plans for raising workers' pay this year. This is not an exhaustive list. This webpage was last updated on Aug. 15. 

Factors associated with Do Not Resuscitate status and palliative care in hospitalized patients: A national inpatient sample analysis Palliative Medicine Reports; by Jean-Sebastien Rachoin, Nicole Debski, Krystal Hunter, Elizabeth CerceoIn the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.

Why more than 30% of rural hospitals are at risk of closureMedCityNews; by Katie Adams; 8/8/24More than 700 hospitals across the rural U.S. are at risk of closing due to their financial woes — and for more than half of these hospitals, the risk of closure is immediate, according to a new report. The report argued this is due largely to inadequate reimbursement from health plans. More than 700 hospitals across the rural U.S. are at risk of closing due to their financial instability — that’s over 30% of the country’s rural hospitals. And for more than half of these 700 hospitals, the risk of closure is immediate, according to a new report from the Center for Healthcare Quality and Payment Reform (CHQPR).Publisher's note: The CHQPR report linked above is very interesting, including a table listing states with the most hospitals at immediate risk of closing - the top 5 states are Kansas, Texas, Oklahoma, Mississippi, and Alabama.

Hospital assets before and after private equity acquisitionJAMA; by Elizabeth Schrier, Hope E M Schwartz, David U Himmelstein, Adam Gaffney, Danny McCormick, Samuel L Dickman, Steffie Woolhandler; 7/24Private equity firms spent $505 billion on health care acquisitions between 2018 and 2023. Financial infusions may augment resources for care. However, firms have sometimes sold acquired hospitals’ land and buildings, repaying investors with proceeds and burdening hospitals with rent payments for facilities they once owned. We assessed changes in hospitals’ capital assets after private equity acquisition. After private equity acquisition, hospital assets decreased by 24% relative to that of controls during 2 years. Private equity acquisitions appear to have depleted, rather than augmented, hospital assets. Although funds from asset drawdowns might be redeployed to enhance care or efficiency, previous studies suggest such effects may not occur.

Steward to lay off more than 1,200 Massachusetts hospital workersModern Healthcare; by Alex Kacik;8/5/24Dallas-based Steward plans to cut 753 workers at Carney Hospital in Dorchester and 490 employees at Nashoba Valley Medical Center in Ayer on Aug. 31, according to two Worker Adjustment and Retraining Notification Act filings.