Literature Review

Year-over-year health spending growth highest ‘by far’ for home healthcare McKnights Senior Living; by Lois A. Bowers; 7/28/24 Year-over-year growth in national health spending in June was highest “by far” for home healthcare, at 20.9%, compared with other major healthcare categories, according to a brief issued late Tuesday by Altarum. Most of the growth, 18.5 percentage points, was due to changes in utilization rather than price, George Miller, PhD, Altarum fellow and research team leader, told the McKnight’s Business Daily. “Nursing home care spending was a distant second, at 10.0% year-over-year growth,” Miller said. By comparison, year-over-year spending growth was 8.3% for prescription drugs, 8.2% for hospital care, 7.3% for dental services and 6.6% for physician and clinical services, according to the report. Overall, spending on healthcare goods and services grew by 8.1% between June 2023 and June 2024, with utilization growth continuing to outpace price growth.

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. 

‘Lean into your superpowers’: Bayada COO champions women in home health leadership Home Health Care News; by Audrie Martin; 8/20/24 Heather Helle, president and chief operating officer of Bayada Home Health Care, believes that home-based care could benefit from having more women in leadership roles. Founded in 1975 and headquartered in Moorestown, New Jersey, Bayada provides in-home clinical care and support services for children and adults, including hospice, behavioral health, and rehabilitation in 21 states and five countries. ... In 2022, women accounted for approximately 80% of workers in health care occupations, a figure higher than the percentage of women in all other employment sectors, as reported by the Bureau of Labor Statistics. ... However, women are underrepresented in leadership roles, comprising only 25% of health care leadership positions in 2022. ... Gender equity is crucial for developing resilient health systems and gender-transformative health and social care policies, according to The World Health Organization. 

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.

Alzheimer’s prognosis models should expand data sources McKnights Senior Living; by Kristen Fischer; 8/12/24 Integrating data from nursing home electronic health records and claims in addition to the minimum data set — data required for nursing home residents — could be better than just relying on the MDS sources to produce an accurate prognosis for nursing home residents with Alzheimer’s disease and related dementias, according to a report published Thursday in the Journal of the American Geriatrics Society. ... The authors of the report noted that a recent review of prognostic models for late-stage ADRD found that assessments commonly used to evaluate prognosis-based eligibility for hospice weren’t reliable. ... Only 15% of people enrolled in hospice have a primary diagnosis of ADRD. That’s because it’s challenging to estimate the six-month prognosis required to be eligible for hospice, and dementias have a prognosis of 12 to 18 months when they are in the late stage, the authors pointed out.

Four Years And More Than 200,000 Deaths Later: Lessons Learned From The COVID-19 Pandemic In US Nursing HomesHealth Affairs; by R. Tamara Konetzka, David C. Grabowski, Vincent Mor; 7/24Nursing home residents and staff were disproportionately affected by the COVID-19 pandemic, drawing attention to long-standing challenges of poor infection control, understaffing, and substandard quality of care in many facilities. Evolving practices and policies during the pandemic often focused on these challenges, with little effect. Despite the emergence of best practices to mitigate transmission of the virus, even the highest-quality facilities experienced outbreaks, indicating a larger systemic problem, rather than a quality problem at the facility level. Here we present a narrative review and discussion of the evolution of policies and practices and their effectiveness, drawing on evidence from the United States that was published during 2020–23.

No prison for nursing home owner who botched Hurricane Ida evacuation, leading to 7 resident deathsMcKnight's Long-Term Care News; by Josh Henreckson;7/23/24Bob Dean has been sentenced to three years of probation and must pay more than $1.3 million in restitution and penalties for his role in the disastrous emergency evacuation of nearly 850 residents from his seven Louisiana nursing homes during Hurricane Ida. The 2021 emergency evacuation to a warehouse Dean owned near New Orleans left the residents of his nursing homes in a state of overcrowding and neglect. Seven died within days of the storm — with hundreds more rescued by state officials. Dean pleaded no contest to 15 state criminal charges, including multiple counts each of cruelty to the infirmed, obstruction of justice and Medicaid fraud.

A blood test accurately diagnosed Alzheimer’s 90% of the time, study finds The New York Times; by Pam Belluck; 7/28/24 The New York Times says researchers “reported that a blood test was significantly more accurate than doctors’ interpretation of cognitive tests and CT scans in signaling” Alzheimer’s disease. The study “found that about 90% of the time the blood test correctly identified whether patients with memory problems had Alzheimer’s,” while “dementia specialists using standard methods that did not include expensive PET scans or invasive spinal taps were accurate 73% of the time” and “primary care doctors using those methods got it right only 61% of the time.” The findings were published in JAMA and presented at the Alzheimer’s Association International Conference.

Despite past storms’ lessons, LTC residents again left powerless: How a long-term care facility prepares for and handles power outages is one of the first questions potential residents should ask KFF Health News - Rethinking65; by Sandy West; 7/29/24 ... Even after multiple incidents of extreme weather — including a 2021 Texas winter storm that caused widespread blackouts and prompted a U.S. Senate investigation — not much has changed for those living in long-term care facilities when natural disasters strike in Texas or elsewhere. ... [While] nursing homes face such federal oversight, lower-care-level facilities that provide some medical care — known as assisted living — are regulated at the state level, so the rules for emergency preparedness vary widely. ... Editor's Note: While this article is written for the public, its content applies to all hospices that (1) provide hospice facility care, and/or (2) partner with senior care facilities: nursing homes, long-term care, assisted living, senior living communities, and PACE. This can be an important QAPI analysis and gap improvement. 

Baptist Health taps 3 vendors to build a population health system that works Healthcare IT News; by Bill Siwicki; 7/26/24With help from Oracle, Innovaccer and Salesforce, the South Florida provider is scoring big population health wins, including a 7% increase in coding gap closure rate and a 17% increase in annual wellness visit completion rates. Baptist Health South Florida operates a network of 11 hospitals covering four counties. It also includes numerous ambulatory facilities, urgent care centers and emergency departments to provide comprehensive healthcare services across the region. ... "One of our primary issues was the fragmented nature of patient data across multiple provider organizations and electronic health record systems," said Milady Cervera, vice president, population health and physician integrated networks, at Baptist Health South Florida. "This lack of interoperability made it difficult to gain a comprehensive view of our patients' health status, care history and ongoing needs. ..."

Advance care questions to ask your loved one Parkview Health; 7/27/24 ... To ease into a conversation about decisions and scenarios, we can start with questions that are easier to answer, like: What does a good day look like? If you got to spend the day with your favorite people doing your favorite things, what would you be doing? With whom? ... From there, we can talk about more specifics related to healthcare decisions, such as: If your heart and breathing stop suddenly, would you want to have CPR (cardiopulmonary resuscitation), which can include pushing on your chest, breathing support, medications, and electrical shocks? ... If you knew that death was likely to happen in a brief period of time, would you want to be in the hospital, in a nursing care facility or at home? ... Editor's Note: The wording, sequencing, and open-ended format of these questions gently open the door for the person to reflect on and describe one's wishes, in contrast to some advance care planning questions that focus on filling out a form. Yes, Advance Directives forms are crucial. However, the forms are a tool for now and for needs ahead. The focus is the person, while building a context of relationship and trust.