Literature Review

Caregiving under the Medicare Hospice Benefit JAMA Internal Medicine - Viewpoint Aging and Health; by Helen P. Knight, MD; Richard E. Leiter, MD, MA; Harry J. Han, MD; 9/8/25 As palliative care physicians, we frequently refer patients to hospice care. When we do so, we often worry about them. How will they and their families manage custodial care—the day in, day out, physical and financial demands of caregiving—on top of navigating the inherent challenges of end of life? We know that high-quality hospice agencies provide patients and their families with invaluable support for symptomatic, emotional, and spiritual needs. But in the US, due to constraints of Medicare reimbursement, hospice agencies provide only limited custodial care support; this lack of assistance often is an unwelcome surprise to our patients and families and profoundly shapes their end-of-life experience.

Husband and wife have emotional reunion after a year apart while dealing with dementia People; by Sam Gillette; 9/4/25 "We are humbled to help turn final wishes into treasured memories," a hospice official says of Everett Linton and his wife. ... An 88-year-old former truck driver from Cincinnati was able to hitch a ride to see his wife for the first time in almost a year, leading to an emotional reunion. “I'm ridin', I'm going to see my wife,” Everett Linton told a reporter from ABC affiliate WCPO from the passenger seat of a semi-truck. The nostalgic ride and reunion on Aug. 22 were organized by his care facility, Luminary Hospice Cincinnati, and the facility where his wife, Patricia, is staying, Majestic Care of Fairfield Assisted Living in Fairfield, Ohio.

How ‘The Pitt' gets death right Hollywood Reporter; by Ingrid Schmidt; 9/8/25 Boasting 13 Emmy nominations and four recent TV Critics Association Award wins, HBO Max's breakout medical drama The Pitt has been widely lauded for its hyperrealistic portrayal of a chaotic, underfunded hospital emergency department. Among the many things the show has been credited for getting right is its nuanced depiction of death and dying. The Pitt cuts deep into the heart of harrowing end-of-life decisions and conversations faced by patients, family members and physicians, as well as the messy emotional aftermath. Editor's Note: Ira Byock, MD--pioneer palliative physician--significantly contributed to The Pitt's death stories. Explore more in our previous posts: Social Media Watch 6/20/25 and “It’s an homage”: Noah Wyle quietly sneaked in a tribute in one of the best episodes of ‘The Pitt’ . Additionally, we thank Dr. Byock for serving as a guest editor in our newsletter. 

When I go, I'm going green KFF Health News; by Paula Span; 9/8/25 More Americans are choosing burials in which everything is biodegradable. ... Although a consumer survey conducted by the National Funeral Directors Association found that fewer than 10% of respondents would prefer a green burial (compared with 43% favoring cremation and 24% opting for conventional burial), more than 60% said they would be interested in exploring green and natural alternatives. “That has to do with the baby boomers coming of age and wanting to practice what they’ve preached,” Webster said. “They’re looking for environmental consistency. They’re looking for authenticity and simplicity.” ... “Do you see a lot of interest in green burials?” I asked the friendly town cemetery commissioner who was showing me around. “I don’t think we’ve had a traditional burial in two years,” he said. “It’s all green.”Editor's Note: What trends are choices for green burials are active in your service areas? Are your teams equipped with relevant referral information? For extensive, reputable research and resources about green burials, examine the National Funeral Directors Association (NFDA) webpage, Green Burial. 

Nursing homes can disrupt ‘rehabbed to death’ cycle with PDPM-based palliative care Skilled Nursing News; by Kristin Carroll; 9/7/25 ... Skilled nursing facilities can leverage the Patient Driven Payment Model (PDPM) to provide more palliative care to people near the end of life, helping to drive value-based care goals while improving the patient experience. However, much more needs to be done on the policy level to disrupt the current status quo, in which people commonly go through several care transitions near the end of life, driving up costs across the health care system while patients receive services that are not aligned with their own goals. Enabling concurrent SNF and hospice care is one change that could lead to improvement. These are assertions in the recent article “Rehab and Death: Improving End-Of-Life Care for Medicare Skilled Nursing Facility Beneficiaries,” published in the Journal of the American Geriatrics Society.

This is the one question leaders need to ask themselves: To avoid burnout, leaders need to pay attention to their energy levels Forbes - Work Life; by Tim Jack Adams; 9/1/25 You’ve carried the weight of big decisions, the pressure to perform, to lead and deliver, all despite what’s happening behind the scenes. You’ve navigated through uncertainty and change, providing the space for everyone else to thrive. It’s a feeling that the most capable leaders feel. It’s not quite burnout, but a kind of dullness. A slow drain. A fog that creeps in quietly and makes it harder to stay clear, connected, and grounded. ... It's not about time, it's about energy. ... To help people understand and manage their energy, my team and I developed a framework that assesses four key domains in under 60 seconds:

CMS: Annual Change in Medicaid Hospice Payment Rates—ACTIONCMS, Department of Health and Human Services; email from Rory Howe, director; 9/5/25The Centers for Medicare and Medicaid Services (CMS) has released the Medicaid hospice rates for FY 2026. They are slightly different than the Medicare rates and should be used when billing for Medicaid hospice patients. This memorandum contains the Medicaid hospice payment rates for federal fiscal year (FY) 2026. The rates reflect changes made under the final Medicare hospice rule published on August 1, 2025 (CMS-1835-F). Please inform your staff and all state agencies in your jurisdiction of these new payment rates, which are effective October 1, 2025. We expect state agencies to share the Medicaid hospice payment rates for FY 2026 with the hospice providers in their state.

Knowledge is power. ~Francis Bacon

Are we growing leaders? Exploring leadership training in hospice and palliative medicine fellowshipJournal of Pain & Symptom Management; by Lynn A Flint, Greg Wallingford, Paul Tatum, Julie Bruno, Helen Fernandez, Elise C Carey; 8/25The purpose of this study was to characterize the current state of leadership curricula in HPM fellowships and understand which leadership topics fellowship program directors (PDs) consider to be most important to include in a leadership curriculum for fellows. Respondents rated leadership topics as important for training, yet many topics are not included in fellowship curricula. Six topic areas related to communication and self-management were rated as having great need or were included in existing curricula by more than 60% of respondents. PDs identified ten topics to be of great need for fellows, all but one of which were included in at least 40% of programs' curricula. Negotiation was the exception being included in only 20% of programs' curricula.

Patient-and caregiver-identified goals for advance care planning in patients with dementia or cognitive impairmentDementia; by Kristin L Rising, Angela M Gerolamo, Nazanin Sarpoulaki, Venise J Salcedo, Grace Amadio, Robin Casten, Anna Marie Chang, Alexzandra T Gentsch, C Virginia O'Hayer, Barry Rovner, Brooke Worster; 8/25Despite an aging population and acknowledged importance of advance care planning (ACP) for persons living with cognitive impairment, few engage in ACP. Most existing tools to facilitate ACP discussions focus on medical outcomes, despite research documenting that persons with cognitive impairment often have quality of life outcomes as primary goals. This qualitative study engaged persons with mild cognitive impairment (MCI) or dementia and their carers to identify outcomes that are most important to inform development of a tool to guide ACP interventions with this population. Participants identified 23 outcome categories for ACP interventions within the following six domains: social life, family involvement, current lifestyle, physical independence, financial independence and healthcare goals. Of the 23 outcome categories, the majority (86%) were quality of life goals and only a small fraction (14%) were healthcare specific.

The role of PMHNPs in palliative psychiatry: An ethical framework for care when remission is unattainableJournal of Hospice and Palliative Nursing; by Trae Stewart; 8/23Patients with serious and persistent mental illness may experience intractable suffering despite exhaustive treatment, challenging the dominant curative paradigm in psychiatry. Palliative psychiatry offers an emerging alternative-prioritizing comfort, dignity, and quality of life when remission is no longer attainable. This article presents a comprehensive ethical and clinical framework for integrating palliative psychiatry into psychiatric-mental health nurse practitioner (PMHNP) practice. Drawing parallels with somatic palliative care, the author explores the theoretical foundations, diagnostic complexities, and ethical imperatives guiding palliative psychiatry. Legal challenges, such as hospice eligibility criteria and involuntary treatment statutes, are also examined, with recommendations for practice and policy reform. Assistant Editor's note: As I search for pertinent articles to add to this newsletter, I am delighted to find so many that address a variety of aspects of palliative care. I see articles on palliative care in the ED, palliative care for special populations, palliative care for transplant patients, and as highlighted in this article, palliative care in psychiatry. It makes me think that maybe, just maybe(!), the many benefits of palliative care are finally being recognized and embraced by mainstream health care.

Clinicians who practice primarily in nursing homes and the quality of care for residents with Alzheimer Disease and related dementiasJAMA Health Forum; by Hyunkyung Yun, Mark Aaron Unruh, Yuting Qian, Yongkang Zhang, Hye-Young Jung; 8/25In this cohort study, receipt of care from a SNFist [skilled nursing facility specialist] vs a non-SNFist was associated with a 7% decrease in the odds of a hospitalization and a 7% decrease in the odds of an emergency department visit for an ambulatory care–sensitive condition among residents with dementia. Findings of this cohort study suggest that the use of SNFists by NHs [nursing homes] may enhance the quality of care for residents with ADRD [Alzheimer disease and related dementias].

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.