Literature Review

Americans who’ve become caregivers rose by a third in 10 years The Daily Sentinel, Grand Junction, CO; 2/14/25 A growing numbers of family members now provide care for older adults who live at home or in residential care settings, a new study shows. Their ranks increased 32%, from 18.2 million to 24.1 million, between 2011 and 2022, according to new research in the journal Health Affairs. The number of hours that these folks spent caring for older adults with dementia jumped by nearly 50%, from an average 21.4 hours per week in 2011 to 31 hours in 2022. Exactly what is driving the increase in family or unpaid caregiving is not fully understood, but researchers speculate that it may be due to a rise in the number of people who live with the folks who they assist. For the study, researchers culled data from the National Health and Aging Trends Study (NHATS) and the National Study of Caregiving (NSOC) in 2011 and 2022.  

What's keeping CFOs up at night? Becker's Hospital CFO Report; by Alan Condon; 2/14/25 As health system CFOs chart their course for 2025, they face an increasingly complex financial landscape marked by mounting labor costs, tightening margins, shifting payer dynamics and an evolving regulatory environment. ... [Several] CFOs recently joined the “Becker's CFO and Revenue Cycle Podcast” to discuss the trends they're watching most closely — and the strategies they're deploying to stay ahead. [Key items include the following: labor shortages (key theme); major investments in ambulatory care facilities; AI to support operations and service; physician partnerships; shift from fee for service to value-based care; clinical labor; malpractice litigation; growth of Medicare Advantage programs; staffing shortages; inflation; reimbursements; providing care to undersinsured patients; Medicaid supplemental funding programs; "disruptors' by private equity and "other nontraditional players"; uncertainty of federal and state regulation changes.]

Patrick Mahomes' grandfather dies days after Chiefs' Super Bowl heartbreak Fox News; by Paulina Dedaj; 2/14/25 The grandfather of Kansas City Chiefs quarterback Patrick Mahomes has died just weeks after being put in hospice care, the NFL star’s mother confirmed Friday. Randi Mahomes shared a post on Instagram announcing the passing of her father, Randy. The heartbreaking news for the Mahomes family comes just days after the Chiefs suffered a crushing loss to the Philadelphia Eagles in Super Bowl LIX. [Click here for their previous post, Patrick Mahomes' grandfather reportedly 'hanging on' in hospice care to watch grandson play in Super Bowl LIX]

Leadership should be born out of understanding the needs of those who will be affected by it. ~ Marian Anderson

Humana posts $693M loss in Q4 Becker's Payer Issues; by Jakob Emerson; 2/11/25 Humana lost $693 million in the fourth quarter of 2024, according to the company's year-end earnings report published Feb. 11. The results reflect increased benefits expenses, particularly in Medicare Advantage and state-based contracts. Despite the challenges, the company projected earnings per share of $15.88 for 2025, with an adjusted EPS of approximately $16.25. Total revenues in the fourth quarter were $29.2 billion, up 10.4% year over year. In 2024, total revenues were $117.8 billion, up 10.7%. Humana posted a net loss of $693 million in the fourth quarter, compared to a $541 million net loss the year prior. In 2024, the company's net income totaled nearly $1.2 billion, down 52%.

The number of family caregivers helping older US adults increased from 18 million to 24 million, 2011–22 Health Affairs; by Jennifer L. Wolff, Jennifer C. Cornman, and Vick A. Freedman; 2/25 The evolving composition and experiences of the family caregiver workforce have profound ramifications for public policy but are not well understood. Drawing on the linked National Health and Aging Trends Study and National Study of Caregiving, we found that the numbers of family caregivers providing help to older adults increased by nearly six million between 2011 and 2022, rising from 18.2 million to 24.1 million. ... For family caregivers as a whole, challenges persist, and for those assisting people with dementia, tailored surveillance and effective support programs are needed.

Death Matters: The gift of presence: Tips for visiting someone who is dying Squim Gazette, Squim, WA; by Jeanette Stehr-Green, Volunteer Hospice of Clallam County; 2/12/25 We sometimes avoid visiting friends or family members who are terminally ill. We make lots of excuses. We don’t know what to say. We don’t know how to act. We don’t want to be a bother. The hard truth is that dying, the final stage of life, can be a lonely experience without the presence of family and friends. A visit during this time can bring comfort to the dying person and their family. It can also provide an opportunity to share feelings, reminisce, and say goodbye. Visiting a dying person seems difficult because most of us lack experience. It only takes a little courage and a few ideas to create a meaningful moment. ... Editor's note: These excellent guidelines empower hospice patients' families and friends--and protect patients' vulnerable energies and emotions--in multiple settings across the trajectory of dying. How might you adapt these for your own patient/caregiver support and community outreach?

The talk nurses don't talk about enough: Death and dying Nurse.org - Nurse Converse podcast; by "Courtney" DNP, APRN, AGNP-C; 2/11/25 ... Nursing and medical curricula extensively cover subjects such as pathophysiology, pharmacology, and anatomy, yet they often fail to provide structured training on effective communication regarding death and dying. In the podcast, the hosts recall their own educational experiences, noting that they were not equipped with the tools or frameworks necessary to engage in these sensitive discussions. One telling example from a medical course on difficult conversations revealed that when students were asked if they had received any training on the subject, not a single hand was raised. 

Hospice provider sues to demand denied employee retention credit Bloomberg Law; by Tristan Navera; 2/13/25 Hospice healthcare provider Passages LLC is contesting the IRS denial of a $663,000 employee retention credit, arguing that it’s eligible for the coronavirus incentive program due to the disruptions it faced during the pandemic. The New Orleans-based company said the IRS wrongly denied its claim for the ERC credit—a program that reimbursed companies for keeping workers on the payroll during the economic disruption caused by Covid-19—for one quarter of 2021. The company endured partial suspension of its operations and should qualify, it told the US District Court for the Eastern District of Louisiana.

Hospice leaders applaud CMS’s decision to reevaluate Special Focus Program, call for meaningful reforms National Alliance for Care at Home, Washington, DC and Alexandria, VA; Press Release; 2/14/25 Effective February 14, 2025, the Centers for Medicare & Medicaid Services (CMS) has ceased the implementation of the Hospice Special Focus Program (SFP) so that CMS may further evaluate the program. This decision is a positive move acknowledging that the current approach is not working as intended. The hospice community has long advocated for strong oversight and patient protections, but the SFP, as implemented, was deeply flawed, unlawful, and harmful to the very patients it was meant to protect. A multi-state coalition of hospices and hospice associations took legal action in January to challenge the program, citing its misrepresentation of hospice compliance records, misleading data, and jeopardized access to high-quality end-of-life care. The flawed algorithm behind the SFP failed to distinguish fraudulent providers from reputable ones, disproportionately penalized well-established hospices, and ignored repeated warnings from congressional leaders and industry stakeholders. ... Now that CMS is reassessing its approach, there is an opportunity to ensure that oversight efforts truly enhance patient protections without restricting access to trusted hospice providers. The National Alliance for Care at Home (the Alliance) and the National Partnership for Healthcare and Hospice Innovation (NPHI) remain committed to protecting access to high-quality hospice care and ensuring that regulatory oversight is fair, transparent, and aligned with congressional intent. ... [Click on the title's link to continue reading.] 

Suzetrigine: First-in-class nonopioid pain therapy is approved by FDAAmerican Journal of Managed Care; Giuliana Grossi; 1/25Suzetrigine (Journavx; Vertex Pharmaceuticals) received approval from the FDA for the treatment of adults with moderate-to-severe acute pain, according to an announcement from Vertex. The therapy is a novel oral, non-opioid, highly selective NaV1.8 pain signal inhibitor ... offering a non-opioid alternative amid the opioid crisis. Clinical trials demonstrated significant efficacy in postsurgical pain relief, though results varied across different conditions. Despite this, suzetrigine offers the potential to energize the nonopioid pain market, which includes other companies like Tris Pharma, Latigo Biotherapeutics, and SiteOne Therapeutics—all actively developing alternatives to opioids. Key findings from the Institute for Clinical and Economic Review analysis of the phase 3 trials include potential lifetime cost savings of $200 per patient when comparing suzetrigine with opioids, assuming a 1-week course priced at $420.

Researchers outline new research priorities in neuropalliative care UNC Health and UNC School of Medicine, Chapel Hill, NC; by Winnie K. Lau, MD and David Y. Hwang, MD2/7/25... An emerging field, termed “neuropalliative care,” has taken shape over the past few years to help provide impactful, holistic care for patients with serious neurological disease. And now, experts in the field are seeking ways to improve the overall wellbeing of their patients and loved ones through the power of research. ... A special communication in JAMA Neurology, first-authored by Winnie K. Lau, MD, a neurocritical care physician and associate professor of neurology and senior-authored by David Y. Hwang, MD, professor of neurology and division chief of neurocritical care, describes needed research that can help advance patient care, including:

Palliative care initiated in the Emergency Department-A cluster randomized clinical trialJAMA; Corita R. Grudzen, MD, MSHS; Nina Siman, MA, MSEd; Allison M. Cuthel, MPH; Oluwaseun Adeyemi, MBBS, PhD; Rebecca Liddicoat Yamarik, MD; Keith S. Goldfeld, DrPH, MS, MPA; PRIM-ER Investigators; 1/25Question-What is the effect of a multicomponent intervention to initiate palliative care in the emergency department on hospital admission in older adults with serious, life-limiting illness? In this cluster randomized clinical trial, which was conducted at 29 US emergency departments and included 98,922 initial visits, there was no difference in the rate of hospital admission in older adults with serious, life-limiting illness receiving care before (64.4%) vs after (61.3%) emergency department clinical staff receipt of a multicomponent primary palliative care intervention. Relevance-This multicomponent intervention to initiate palliative care in the ED did not have an effect on hospital admission, subsequent health care use, or short-term mortality in older adults with serious, life-limiting illness.