Literature Review

One year after Hurricane Helene: Lessons in resilience, recovery, and renewal Hospice & Palliative Care Today; Joy Berger and Cordt Kassner with Vern Grindstaff, Millicent Burke-Sinclair, and Chris Comeaux; 9/26/25 At this time last year, Hospice & Palliative Care Today brought you a series of articles reporting on the devastating impact of Hurricane Helene across the Southeast, focusing on hospices in the North Carolina mountains. We remain deeply grateful for the many ways you—our readers and colleagues—rallied in support of those hospice organizations and their communities during their time of urgent need. This Saturday, September 27, 2025, marks the one-year anniversary of that epic disaster. To reflect on what has been learned and how recovery has unfolded, Vern Grindstaff (CEO of Compassionate Care WNC, Burnsville, NC), Millicent Burke-Sinclair (President and CEO of Four Seasons, Flat Rock, NC), and Chris Comeaux (President and CEO of Teleios Collaborative Network, Flat Rock, NC) gathered in conversation with Cordt Kassner (publisher) and Joy Berger (editor-in-chief). The insights that follow honor the hospice employees who persevered to provide urgent patient care. We celebrate their spirit of compassionate community and courageous problem-solving from the onset one year ago through ongoing recovery.

Start where you are. Use what you have. Do what you can. ~Arthur Ashe 

Adult Protective Services work with clients at the end of life: Challenges and support needsJournal of Elder Abuse and Neglect; by Wei-Lin Xue, Joy Swanson Ernst, Pi Ju Liu; 9/25Adult Protective Services (APS) professionals frequently interact with clients who are seriously ill or dying as they investigate cases of elder abuse and self-neglect. This study explored the unique challenges and support needs of APS workers in these end-of-life contexts. Thematic analysis identified two overarching domains: (1) challenges – including family conflict, limited caregiver preparedness, client self-determination, challenges to service access, and emotional strain on professionals; and (2) support needed – such as improved interagency collaboration, peer and organizational support. Participants emphasized the emotional toll of witnessing client decline and death, and highlighted gaps in training, coordination, and workplace support. Findings highlight the need for targeted policy and practice reforms to better equip APS professionals addressing elder abuse and self-neglect at the end of life.

Medicaid coverage policy variations for chronic pain and opioid use disorder treatmentJAMA Network Open; by Meredith C. B. Adams, Seth M. Eller, Cara McDonnell, Sarjona Sritharan, Rishika Chikoti, Amaar Alwani, Elaine L. Hill, Robert W. Hurley, ; 8/25Co-occurring chronic pain and opioid use disorder (OUD) are associated with a high disease burden for the patient, requiring comprehensive treatment approaches, yet Medicaid benefit structures for evidence-based therapies vary substantially across states. Our systematic economic evaluation reveals both promising developments and persistent challenges in Medicaid coverage for treatment of co-occurring OUD and chronic pain. Universal coverage of fundamental medications and basic interventional procedures provides a foundation for care, but varying implementation approaches create a complex landscape requiring further investigation.

Emergency Department care coordination program for assisted living residents with dementia-A qualitative studyJAMA Network Open; Grace F. Wittenberg, Peter T. Serina, Nichole E. Stetten, Ann Reddy, Ellen McCreedy; 8/25Care transitions to the emergency department (ED) from assisted living centers (ALCs) for residents may include incomplete or inaccurate information during transfer. These transitions can be especially difficult for vulnerable populations, including persons living with dementia (PLWD). In this qualitative study of a care coordination intervention, CCMs [complex care managers] advocated for their patients remotely by filling information gaps, particularly for PLWD and patients in hospice, and perceived that the intervention was associated with improved patient care. CCMs also identified key areas for improvement, such as to increase ED staff awareness of the program and to expand program hours.

Emergency physicians and hospice & palliative medicine: A growing trend in fellowship trainingJournal of Pain and Symptom Management; by Alexander Zirulnik, Caroline Meehan, Daniel Markwalter, Jennifer Gabbard, Alyssa Tilly, Paul Zimmerman, Jensy Stafford, Justin Brooten; 9/25Emergency Medicine (EM) has played a foundational role in Hospice and Palliative Medicine (HPM) since the subspecialty's formal recognition. EM is one of the fastest-growing sources of applicants to HPM fellowships, reflecting rising recognition of palliative care's value in acute care. This trend has important implications for workforce planning, specialty integration, and the future of dual-trained EM-HPM clinicians.

Communication surrounding treatment preferences for older adults with dementia during emergency medical services responseJournal of the American Geriatrics Society; by Lauren R. Pollack, Danae G. Dotolo, Anna L. Condella, Whitney A. Kiker, Jamie T. Nomitch, Elizabeth Dzeng, Nicholas J. Johnson, Thomas D. Rea, May J. Reed, Michael R. Sayre, Erin K. Kross; 9/25Emergency Medical Services (EMS) providers, capable of rapidly delivering life-prolonging interventions, are often first to respond to acute health concerns for older adults in the United States. Prior work has shown a preference among many people with dementia for comfort-focused care near end-of-life. EMS providers treating critically ill older adults with dementia face challenges that may hinder their ability to elicit treatment preferences, in particular when responding to calls from professional caregivers. Direct communication with surrogate decision-makers may facilitate goal-concordant care.Assistant Editor's note: Being an RN for over 40 years, I have seen many changes in health care, especially in what is expected now of patients/families. I remember the day when nurses were not permitted to share with the patient his/her own BP reading; instead, we were to tell patients to "ask the doctor". Back then the doctor controlled almost all aspects of the patient's care, as well as the sharing of information with the patient about his/her own medical condition. I am glad those days are gone. Now, patients are expected to engage in ongoing discussions regarding advance care planning, execute written advance directives, and are expected to share their care preferences with health providers and loved ones and/or caregivers. It would be an ideal world where health care providers were continuously aware of evolving patient preferences and could always deliver goal concordant care. I believe we need to keep working toward this goal, but I also understand that this expectation can add burden to patients who are already extremely burdened with the many difficult aspects of serious illness. I believe that, as health care providers, we need to appreciate that some people simply cannot or will not share their preferences; it is simply too scary, too foreign, too difficult to do so.

By working faithfully eight hours a day, you may eventually get to be boss and work 12 hours a day. ~ Robert Frost

Grieving someone who’s still here Psychology Today; by Bob Uslander, MD; 10/2/25 Grief does not always begin after death. For many families facing dementia, terminal illness, or a slow decline, it arrives before the final goodbye—quietly, persistently, and often without recognition. This is known as anticipatory grief: the emotional process of mourning a loved one who is still alive. As a palliative care physician, I see this every day. Spouses tell me they feel like they have already lost their partner. Adult children struggle with the reversal of roles, becoming the caregiver to the parent who once cared for them. Caregivers often oscillate between love, exhaustion, guilt, and detachment. None of this means they are doing it wrong. It means they are grieving.

Sought-after physician specialty roles are taking longer to fill Modern Healthcare; by Tim Broderick; 9/24/25 The time it took to fill open positions for the most sought-after physician specialties increased to almost five months in 2024, according to new research. The nonprofit Association for Advancing Physician and Provider Recruitment, with research firm Industry Insights, examined 2024 data from more than 15,000 searches of the association’s site, 61% of which were related to physician searches. ... The analysis found the estimated median days to fill the selected jobs increased by 11.5%, to 145 days in 2024 from 130 days in 2023. Oncology positions were the hardest to fill, at an estimated median of 332 days. Cardiology positions followed with an estimated median of 248 days to fill. [Access to the full article might be limited per a paywall.] Editor's Note: Oncology and cardiology are now the two hardest physician specialties to fill. This matters for hospice care because, according to NHPCO’s Facts and Figures 2024, cancer and circulatory diseases join Alzheimer’s and other nervous system disorders as the top three hospice diagnoses—together representing nearly three-fourths of all admissions. Delays in recruiting oncologists and cardiologists risk postponing timely palliative and hospice referrals. Newly hired specialists in these fields also need focused training—and intentional relationship-building with hospice teams—to ensure patients and families receive seamless, compassionate care.

Welcome to fall top news stories September 2025 Teleios News Stories (TCN); pod/videocast hosted by Chris Comeaux with Cordt Kassner; 10/1/25As the seasons shift, so do the conversations shaping Hospice and Palliative Care.  In this week’s episode, host Chris Comeaux and Hospice data expert and co-host Cordt Kassner explore the latest headlines, challenges, and innovations impacting Hospice and Palliative Care. ... Covering a range of topics, including the impact of AI on Hospice Care, the importance of end-of-life visits, and the challenges of Hospice utilization trends.  Also highlights significant events and stories from the Hospice community, such as the launch of a new nursing scholarship program and the impact of Hurricane Helene one year later.

Chico nurses at Enloe Health to hold rally to protest closure of home health and hospice units National Nurses United; Press Release by the California Nurses Association/National Nurses United; 10/1/25 ... Nurses are calling on the hospital to protect the health of some of Chico’s most vulnerable patients and maintain the essential services and end-of-life care provided by these units.  “For years, Enloe hospice stood alone in providing care for underserved Medi-Cal patients and for our youngest, most fragile patients—children at the end of life,” said Ruby Khoury, registered nurse in the hospice unit. “A vital, compassionate service is being taken away, and a hospital that once led with dignity and inclusivity in hospice care now faces a painful void. We nurses demand that the home health and hospice units remain open. Otherwise, the most vulnerable will suffer first: children, Medi-Cal patients, families without resources.”

Pennant Group completes strategic acquisition of operations Investors Hangout; by Ryan Hughes; 10/2/25 ... Pennant Group is set to integrate operational assets worth approximately $146.5 million, encompassing various home health, hospice, and personal care services primarily situated in the Southeast. This acquisition includes 54 locations across multiple states, primarily focusing on the healthcare needs of communities in the region. ... An important aspect to highlight is that about two-thirds of the total revenue is associated with home health services, while the remaining third is linked to hospice care.