Literature Review

One Senior Place: What legal steps should be taken after dementia diagnosis? Florida Today; by Brenda Lyle; 10/1/24 After a dementia diagnosis, preparing key legal documents early helps families focus on the quality of life for their loved one. ... Dementia is a term for many progressive neurodegenerative disorders that affect memory, thinking, and behavior. Alzheimer accounts for about 60% of all dementias. As the disease advances, individuals may lose the ability to make informed decisions about their health care, finances and other important aspects of life. Legal planning is absolutely crucial for ensuring that the wishes of the person with dementia are honored and that their affairs are managed appropriately. This planning also helps reduce stress for family members and caregivers. [Click on the title's link to continue reading for basics about Durable power of attorney, Heath care surrogate, Living will, Last will and testament, and Guardianship.]

Mirror, mirror 2024: A portrait of the failing U.S. health system - comparing performance in 10 nations The Commonwealth Fund; by David Blumenthal, Evan D. Gumas, Arnav Shah, Munira Z. Gunja, and Reginald D. Williams II Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement. Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes. Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower. Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.

Waterbury nursing home residents, caregivers push back against plan to close facility NBC Waterbury, CT; by Amanda Pitts; 9/17/24 A nursing home in Waterbury could close in less than 30 days after losing its federal funding. Abbott Terrace Health Center is home to 180 people and employs 287 caregivers, who are newly unionized and pushing back against the closure. ... The funding was pulled by the Centers for Medicare and Medicaid Services (CMS) after the Connecticut Department of Public Health (DPH) found that the facility didn’t meet safety requirements. It has left residents to find a new place to live and caregivers to find a new place to work.

CMS submits 75,000 pages to federal court to justify nursing home staffing mandate McKnights Long-Term Care News; by Kimberly Marselas; 9/15/24 The Department of Health and Human Services filed more than 75,000 pages of rule-making records with a federal court Friday, beginning its formal defense of its controversial nursing home staffing mandate. The submission of the administrative record is the first significant advance in the case since the American Health Care Association brought its challenge to the minimum staffing standard in late May. The Texas Health Care Association, three Texas providers and LeadingAge are also part of the case. In another development, District Court for the Northern District of Texas Judge Matthew Kacsmaryk on Sept. 10 agreed to fold in a separate federal challenge against the staffing mandate filed by the state of Texas. He noted that the two cases “share common questions of law or fact, consist of similar parties, the same claims, and [have] the same relief sought.”

10 strategies for positive company culture in long-term careMcKnight's Home Care; by Julie Rupenski; 9/11/24Creating a great home care, senior living or other long-term care or organizational culture doesn’t happen by accident. It’s deliberate and requires intentional leadership strategies that foster positive, productive and inclusive work environments. Your leadership has a profound impact on company culture. Strong leaders inspire others with a feeling of direction, purpose, and team collaboration... Here are 10 strategies:

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:

Changes in nursing home ownership may depress care and staffing, report findsMcKnight's Long-Term Care News; by John Roszkowski; 9/4/24Changes in nursing home ownership may have a small, but statistically significant, negative impact on staffing levels and the overall quality of patient care at nursing homes, according to new research. Investigators from the University of Pennsylvania and the Department of Veterans Affairs Medical Center in Philadelphia conducted a retrospective study of changes in nursing home ownership between 2016-2022 and how they impacted nursing home quality of care. Findings appeared in the Journal of the American Geriatrics Society. The researchers used data from the Centers for Medicare & Medicaid Services from 2016-2022 of nearly 3,600 nursing homes that changed ownership to determine if there were noticeable shifts in quality ratings after the properties changed hands.Publisher's note: This study might have interesting implications in the hospice field.

10 ways to improve cancer patients' transition to skilled nursing facilities: Viewpoint Becker's Hospital Review; by Elizabeth Gregerson; 9/5/24Physicians from the New York City-based Memorial Sloan Kettering Cancer Center have shared insights on how to better manage care when an oncology patient transfers from the hospital to a skilled nursing facility setting. ... The authors are oncologist Daniel Lage, MD, palliative care physician Craig Blinderman, MD, and emergency medicine physician Corita Grudzen, MD. ... [Among the] 10 recommendations from the editorial: ... Documentation should be provided to the skilled nursing facility team if an oncologist believes harm from future cancer treatment outweighs potential benefits or believes the patient has a poor prognosis. This will allow palliative care or hospice conversations to occur more urgently. Oncologists and palliative care clinicians can schedule, with hopeful reimbursement for,  telehealth visits for patients in skilled nursing facilities.

Bay Bluffs opens hospice wing as end-of-life care models change Interlochen Public Radio; by Michael Livingston; 9/4/24 Three new beds for hospice care opened in Harbor Springs today marking the end of a year-long pivot for an end-of-life care organization in the region. Last year, McLaren Health System closed hospice facilities in Petoskey and Cheboygan. Combined, the facilities provided more than a dozen beds for hospice in the region. At the time, McLaren called the decision to close "difficult" but necessary due to staffing constraints and said it would move to prioritizing outpatient hospice care - when a nurse visits patients in the home rather than a facility. But a group of advocates in Petoskey said residential hospice is needed in the region - especially for people with serious terminal illnesses. David McBride leads the newly renamed group, Friends of Hospice of Little Traverse Bay. It used to be called the Friends of Hiland Cottage for the facility in Petoskey. ... That’s what led to a partnership with skilled nursing facility Bay Bluffs in Harbor Springs. It’s the Emmet County Medical Care Facility and owned by the county health department. Bay Bluffs is not a licensed hospice provider but it is able to outsource hospice from other companies while providing rooms for families to gather with their loved ones and trained nursing. This newer model of end-of-life care is a growing trend and has been tried in other places such as Arbor Hospice in Ann Arbor which closed its residential facility in 2022.

Employer educational assistance programs can help long-term care workers pay off student loansMcKnight's Senior Living; by John Roszkowski; 9/3/24Employer-based educational programs still can be used to help pay off worker students’ loans through the end of next year, potentially enabling long-term care employers to provide relief to their workers who are struggling to pay off such debt. The IRS issued a reminder last week that employers who offer educational assistance programs also can use them to help pay for their employees’ student loan obligations through Dec. 31, 2025. Although educational assistance programs have been available to employees for many years to help them pay for tuition, books, supplies and other educational expenses, the option to use them to help workers pay off student loans has only been available for payments made after March 27, 2000, according to the IRS. The student loan provision will expire at the end of 2025. The student loan payment initiative may be one way for senior living, nursing home, home care and hospice employers to attract and retain employees, many of whom may be trying to pay off student loans.Publisher's note: Some hospices offer employer-based educational programs - does yours?

$83M fraud case against nursing home group may proceed, with no defendants excusedMcKnight's Long-Term Care News; by Jessica R. Towhey; 8/27/24A New York Supreme Court judge threw out all arguments from lawyers for an embattled group of nursing homes that sought to have charges dismissed in a case accusing the owners and operators of $83 million in Medicare and Medicaid fraud. Judge Melissa Crane ruled that the owners of Centers Health Care, along with numerous other individuals, did not make sufficient arguments for dropping charges of fraud, “saddling” nursing homes with “excessive debts,” colluding to pay “sham vendors,” and paying themselves “inflated” salaries.

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.

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.