Literature Review

Personal conflicts, even violence, are not uncommon in long-term care The New York Times; by Paula Span; 6/9/24... In long-term care facilities, residents sometimes yell at or threaten one other, lob insults, invade fellow residents’ personal or living space, rummage through others’ possessions and take them. They can swat or kick or push. Or worse. Eilon Caspi, a gerontologist at the University of Connecticut, has searched news coverage and coroners’ reports and identified 105 resident deaths in long-term care facilities over 30 years that resulted from incidents involving other residents. The actual number is higher, he said, because such deaths don’t always receive news media attention or are not reported in detail to the authorities. “We have this extraordinary paradox: the institutions, nursing homes and assisted livings who care for the most vulnerable members of our society are some of the most violent in our society,” said Karl Pillemer, a Cornell University gerontologist who has studied resident-to-resident conflict for years. [Click on the article's title for more. Might require subscription to access the full article.]

Governor on hand for PACE openingNews-ExpressKy, Pikeville, KY; by Terry L. May; 6/7/24Mountain View PACE (Program of All-Inclusive Care for the Elderly) was created to help adults 55 years old and older with complex care needs to avoid nursing homes and to receive care and services necessary to help them be safe, comfortable, and healthy while maintaining a more independent lifestyle, Mountain View PACE Medical Director Dr. James Rummel Jr. said. ... “For those of us who have aging parents, we see this cycle of people who are having a hard time living well at home so they tend to do this circle of home to the ER to the hospital to the nursing home for rehab then back home and it keeps repeating.” ... “We are not trying to replace anybody,” Rummel said. “We are trying to augment the system to fill the gaps. We are a niche type of healthcare system.” ... “What a great day in Pikeville and Pike County,” Governor Beshear said. “How we treat our seniors says something about us and our values as a people." 

Five arrested over 'sham hospices' alleged to bilk Medicare for over $15 million Los Angeles Times; by Emily Alpert Reyes; 6/8/24 Angeles over an alleged scheme to bilk the Medicare program of more than $15 million. The U.S. Department of Justice said three of the San Fernando Valley residents who were arrested — Petros Fichidzhyan, also known as Peter; Juan Carlos Esparza; and Karpis Srapyan, also known as Tony Levy — were accused of running "sham hospice companies" and turning in fraudulent claims to Medicare for hospice services. ... As part of the alleged scheme, the three defendants misappropriated the identifying information of doctors to claim those physicians had deemed hospice services necessary for patients, federal prosecutors said. They also allegedly used the names and Social Security numbers of Russian and Ukrainian citizens who had left the U.S. to open bank accounts and sign leases, indicating that the "impersonated identities" were the owners of the hospice companies that they in fact controlled, according to the federal indictment. 

Better bereavement and palliative care priorities are needed internationally ONS Voice - Oncology Nursing Society; by Elisa Becze, BA, ELS; 6/7/24 Palliative and bereavement care should be a health policy priority, an international team of public health scientists reported in Lancet Public Health. They called for interprofessional health workers, organizations, and systems to “shift bereavement care from an afterthought to a public health priority.” The authors cited evidence that bereaved individuals are at increased risk for numerous adverse outcomes, including prolonged grief disorder, mood and anxiety disorders, existential distress, decreased work productivity, adverse health behaviors, cancer, heart disease, suicide, and death. They added that the burden is particularly high for vulnerable groups, including those living in communities with limited resources. Healthcare professionals’ barriers to providing bereavement care are similar to those for palliative care, they said, including:

AccentCare expands hospice care business to Rhode Island HomeCare; 6/7/24 AccentCare, a nationwide provider of home health, hospice and personal care services, announced the opening of its Warwick hospice location and its expansion into Rhode Island after being awarded a Certificate of Need (CON) license in the state. “We are excited to expand our footprint in New England and to provide hospice services to more patients and families in the region,” said Andy Johnston, president of hospice & PCS, AccentCare. “We know the critical role hospice plays in extending the continuum of care to patients and adding dignity to the end of life. We are honored to begin providing high-quality, compassionate care in Rhode Island.” 

Higher sepsis mortality in safety-net hospitals linked to fewer post-discharge care options Contagion Live - Infectious Diseases Today; by Kenneth Bender, PharmD, MA; 6/9/24 Purportedly higher sepsis mortality in safety-net hospitals reflects less a difference in acute care than opportunities to discharge to hospice. By extending the measure of sepsis-related mortality from in-hospital events to occurrences within 30 days after the diagnosis, the purported higher mortality rate of sepsis treated in safety-net hospitals decreased to parity with non-safety-net hospitals, in a retrospective national cohort study. The investigators note the particular challenges of safety-net hospitals, which care for a disproportionately high share of low-income and underinsured patients, include fewer resources and narrower operating margins, as well as patient populations with decreased access to preventative care and more complex disease presentations.

Managing palliative care challenges for patients with complex symptoms Pharmacy Times; 6/7/24In an interview with the Pharmacy Times, Justin Kullgren, PharmD, FAAHPM, Palliative Medicine Clinical Pharmacist Specialist and PGY2 Pain Management & Palliative Care Residency Program Director at The Ohio State University Wexner Medical Center, James Cancer Hospital, shares insights into palliative care and common challenges faced by pharmacists treating patients with complicated symptoms. ... Pharmacy Times: What do you wish pharmacists understood about hospice and palliative care in terms of patient care for patients with complicated symptoms? Kullgren: So, I think, number 1, pharmacists across all healthcare systems, in the hospital, at community pharmacies, long-term care, you are all going to be involved in these patients— it’s just to what degree. ... We want to do those therapies that ... are going to have the least amount of risk for our patients, or at least side effects for our patients. ...

Death with dignity: 50th anniversary of America’s first hospiceYankee Institute; by Andrew Fowler; 6/7/24 ... In the late 19th century, terminally ill patients faced undignified treatment or were even “refused admission to the hospital entirely” due to “availability of space and resources” or race and socio-economic class, according to Doctors, Death, and Denial: The Origins of Hospice Care in 20th Century America by Sarah E. Pajka. ... All of this shaped the outlook of Florence Wald — a former dean of the Yale University School of Nursing, and a Branford native. Growing up in the early 20th century, she recognized the flaws and inhumane nature of medical care toward terminal patients, telling the Associated Press (AP), on Nov. 26, 1971, that death is “a period of life that can have a lot of meaning. It can be content, full of joy, with lots of reminiscing.” But death needed to be “more human and meaningful,” as she stated in the same AP article. Throughout her career, Wald’s passion for palliative care revolutionized the medical profession, with her co-founding “The Connecticut Hospice,” the first in the United States, on June 11, 1974.  Since then, more than 5,200 hospices have been established in the country and millions have sought both in-patient and home care services. This is the story of how the first hospice was founded in Connecticut 50 years ago.  ... Editor's Note: This fascinating history of hospice's beginnnings illuminate core purposes, outcomes (are we measuring the right factors?), and current 21st century challenges. This article is published by the Yankee Institute, not Connecticut Hospice. This author frames this history as a stand against "euthanasia." Whatever one's ethical, political, or religious stand on today's MAiD issues (Medical Aid in Dying)--also referred to as physician assisted suicide--we invite you to find common ground in learning from our history and celebrating Florence Wald's co-founding of The Connecticut Hospice. For readers, what do you know about your hospice organization's history? What might you research and learn? Whom can you honor? Fifty years from now, what will be said of how your organization chose to address 2024's core hospice purposes, outcomes, and challenges?

Rural pharmacy owners say it's getting harder to stay open Times West Virginian; by Devi Shastri; 6/5/24 Rural pharmacies can be a touchstone for their communities. The staff knows everyone’s names and drugs, answers questions about residents’ mail-order prescriptions or can spot the signs of serious illness. But their business models face unrelenting pressures to the point that sometimes they have to close. An AP analysis of data from 49 states and the National Council for Prescription Drug Programs shows that several largely rural states have some of the lowest number of pharmacies per ZIP code. Editor's Note: This trend for closures in rural areas is rampant for hospitals, emergency departments, physicians, and more. Click here for a letter from NHPCO and numerous hospice providers to Congress, Jan. 5, 2024: Protect rural and frontier American's access to hospice and palliative care.

Ohio’s Hospice fundraising event raises record amountAn evening of food, beverages, live and silent auctions, and community support topped off the 19th annual Culinary Capers benefiting Ohio’s Hospice. Thanks to the 225 people in attendance at Rustic Ridge Wedding Barn in New Philadelphia, the event raised over $177,000, shattering the previous record of more than $130,000. This support helps to ensure all in the communities served by Ohio’s Hospice receive the comprehensive end-of-life care and grief support services they need when it matters most, regardless of their ability to pay.

These MD architects want to redesign your hospital Medscape; by Amanda Loudin; 6/5/24Little known fact: Florence Nightingale might have been the most famous clinician to notice and openly comment on the role of hospital design in patient care. In her now well-known writings on nursing, Nightingale advocated for "open windows to maximize light and ventilation," among other elements. Today, a growing group of physician-designers are paying attention to many such details — windows in patient rooms included. Their goal: To build hospitals and medical facilities where design can enhance patient and clinician well-being. ...