Literature Review

The Alliance responds to Senate passage of Reconciliation Bill National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 7/1/25 The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Senate’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill. “The Alliance is alarmed by the Senate’s passage of the One Big Beautiful Bill Act, which prioritizes misplaced budget cuts over the health and wellbeing of our most vulnerable. The legislation will reduce access to care and support for the millions of Americans who rely on home and community-based services (HCBS),” said Alliance CEO Dr. Steve Landers. ... “The Alliance continues to maintain that the complexity of the Medicaid program makes it nearly impossible to reduce expenditures by the amounts contemplated by this legislation – potentially exceeding $1 trillion over ten years – without impacting services to older adults and people with disabilities. The Alliance will advocate on behalf of Medicaid enrollees, families, and providers nationwide ...

How Empath Health integrates end-of-life care into PACEHospice News; by Jim Parker; 6/26/25Under the Programs for All-Inclusive Care of the Elderly (PACE) model, patients generally do not transition to the Medicare Hospice Benefit as they near death. Consequently, Empath Health has taken pains to ensure quality end-of-life care is integrated into its program. Empath considers these services to be a key component of its “Full Life Care” model, that seeks to longitudinally support patients over the course of their serious or terminal illness, according to Dr. Nick Joseph, senior vice president of Empath’s Complete Care Division. The organization provides end-of-life care in the home, with services that mirror its hospice program.

Providence hospice workers to hold 1st strike Becker's Hospital Review; by Kelly Gooch; 6/30/25 Providence workers are set to begin a two-day strike July 2 at Hospice of Petaluma (Calif.) and Memorial Hospice in Santa Rosa, Calif. The action marks their first-ever strike and comes amid ongoing contract negotiations. The strike involves more than 100 nurses, social workers, home health aides, chaplains and other hospice workers, according to their union, the National Union of Healthcare Workers. Union-represented hospice workers have been negotiating their first contract with Renton, Wash.-based Providence since 2023, when they unionized, according to NUHW. They contend that Providence has not adequately bargained — a concern compounded by the system’s planned transition of home-based care services to Compassus through a joint venture. 

HOPE Tool Anxiety, Part II: From planning to practice Teleios Collaborative Network (TCN); by Melissa Calkins; 6/30/25The countdown has begun. With October 1 on the horizon, hospice teams across the country are deep into training and testing—but preparation alone won’t guarantee success. The shift to HOPE isn’t just operational; it’s cultural. And real readiness goes far beyond timelines and task completion. It demands that every clinician, across every shift and care setting, understands what’s changing and feels confident in how to respond. This is the critical moment when planning must translate into practice—because once HOPE is live, the margin for error disappears.

The Alliance Responds to CY 2026 Home Health Proposed RuleNational Alliance for Care at Home, Alexandria, VA and Washington, DC; Press Release; 6/20/25The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Centers for Medicare & Medicaid Services (CMS) Calendar Year (CY) 2026 Home Health Prospective Payment System Rate and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Competitive Bidding Program Updates proposed rule, which proposes payment and regulatory updates for Medicare home health agencies (HHAs). The proposed rule includes policies that would reduce payments to HHAs by over $1 billion dollars in 2026, at a time when providers also continue to experience unmatched inflationary pressure in a challenging labor market — making it difficult, if not impossible in some areas, to deliver care to Medicare beneficiaries entitled to receive it.

Awards and Recognitions: June 2025

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Disparities in receipt of palliative-intent treatment among disaggregated Hispanic populations with breast, lung, and prostate cancer in the United StatesCancer; Shriya K. Garg BS; Khushi Kohli BA; Isha K. Garg BS; Yash K. Garg BS; Lilac G. Nguyen BS; Isabella S. Nguyen BS; Erin Jay G. Feliciano MD, MBA; Yefri A. Baez MD; Brandon A. Mahal MD; Puneeth Iyengar MD, PhD; Daniel R. Gomez MD, MBA; Kaitlyn Lapen MD; Edward Christopher Dee MD; 5/25 This study examines disparities in the receipt of palliative-intent interventions among Hispanic subgroups with advanced lung, breast, and prostate cancer. Among 945,894 total patients, disaggregated analyses revealed reduced receipt of palliative-intent interventions for patients with lung, breast, and prostate cancer of Mexican descent ... compared to non-Hispanic White patients. Receipt for patients of South or Central American descent was reduced in comparison to non-Hispanic White patients for lung and breast cancer ... Uptake of palliative interventions for metastatic lung and breast cancer was reduced for patients of Cuban descent ..., and was lower for patients of Dominican descent with breast cancer, compared to non-Hispanic White patients ... These findings demonstrate disparities in the receipt of palliative-intent interventions among disaggregated Hispanic subgroups. This study highlights the need for disaggregated research to further characterize these disparities and their drivers.

Antibiotics at end of life: Where are we now and where are we going? A narrative reviewAmerican Journal of Hospice and Palliative Medicine; by Patrick D Crowley, Francis X Whalen, Leslie R Siegel, Douglas W Challener; 8/25Antibiotics are frequently prescribed at the end of life, though the benefits and harms are not well understood. Prescribing practices vary based on individual situation and geographic location. Patients with cancer and those hospitalized receive more antibiotics than those enrolled in outpatient hospice. Urinary tract infections and pulmonary infections are the most common conditions treated with antibiotics at the end of life -most often with penicillin derivatives and vancomycin in the hospital, fluoroquinolones in outpatient, and cephalosporins in both settings. When asked, patients most often prefer limiting antibiotics to symptom management at the end of life. Physicians’ over-estimation of patient preference for antibiotics and the increased probability of misdiagnosis increases antibiotic prescription rates. Antibiotics can improve symptoms when used for specific diseases at the cost of drug reactions, resistant organisms, and delayed discharge. Antibiotic use has variable results on survival duration.

Palliative care knowledge, attitudes, and self-competence of nurses working in hospital settingsJournal of Palliative Care; Mona Ibrahim Hebeshy, PhD, RN; Darcy Copeland, PhD, RN; 6/25With the growing need to integrate palliative care into healthcare systems, nurses in hospital settings often provide care for patients with life-limiting conditions, many of whom lack formal education in palliative care. [Conclusions:] Nurses generally feel competent; however, they often lack confidence in addressing patients’ social and spiritual needs. They experienced unease when discussing death and exhibited paternalistic attitudes. Significant differences were found in educational background, nursing experience, personal caregiving experience, and practice setting. Positive correlations exist between attitudes, knowledge, and self-competence, indicating that greater knowledge and competence were associated with better attitudes toward end-of-life care.

Fireproofing the soul: Navigating fear of the afterlife among palliative care patientsJournal of Palliative Medicine; Ptr Shannon Blower, Jonathan Walker, Lucius Walker, Steven Radwany; 6/25Among palliative care patients, spiritual uncertainty about what may await them after death is a fairly common but often overlooked source of anxiety. Specifically, patients (especially those from orthodox Christian backgrounds that propound the concept of hell as a literal place) may harbor unexpressed fears about being consigned to hell due to the perceived sins they have committed in life. Such fears can be genuinely debilitating and may result in non-responsiveness to traditional palliative therapy. Here, we discuss our experiences with this phenomenon and propose some possible solutions. We offer readers suggestions for how to best identify potential sufferers, broach the subject with such patients, and reassure them.

[Spain] “The good death”: Experience of parents who have suffered the loss of a child in a pediatric intensive care unit. A phenomenological studyJournal of Pediatric Nursing; by Sara Alcón-Nájera, Rosa Blanca Ortiz-Pizarro, Elena Peña-Meléndez, Alberto Sánchez-Gallego, María Teresa González-GilThe ‘good death’ condenses experiences of parents into a constructive interpretation. It is characterised by the fact that it is participated, accompanied and honoured. It requires exquisite holistic care (emotional/social/relational and spiritual). It promotes a family-centered approach and emotional wellbeing of parents. The family's perception of a ‘good death’ is a powerful facilitator of bereavement. The experience of the death of a child in a Pediatric Intensive Care Unit must ensure a peaceful, dignified, and respectful death, accompanied and participated in by the family to achieve a “Good Death”. Evidence-based palliative and end-of-life care is essential for developing protocols and resources that ensure excellent support for families and their adaptation to the loss.