Literature Review

“What I wish I knew about hospice”: A Cleveland Clinic palliative care physician’s insights The Healthy; by Dr. Patricia Varacall, DO; 9/3/24 End-of-life care is deeply personal and incredibly complex. An expert MD shares essential insights on hospice: "At its core, is about human connection." … Laura Hoeksema, MD, MPH, FAAHPM, medical director of Cleveland Clinic Hospice and staff physician in the department of palliative and supportive care, explains the importance of hospice: “Death is a part of life just as much as birth is. When time becomes limited, patients need to be able to spend time in a way that’s meaningful to them.” ... Dr. Hoeksema emphasizes that choosing hospice care is exactly that—a choice. The team offers additional support, guiding patients and their families through the last months of life. ... “When a patient has a serious illness, it’s common for their illness to become the primary focus,” reflects Dr. Hoeksema. The constant anticipation of how the disease might progress can create overwhelming anxiety. With hospice, the illness recedes into the background, allowing the emphasis to be on caring for the person as a whole. ... “The most profound healing I’ve witnessed as a physician has been in patients receiving hospice care,” Dr. Hoeksema adds. She recalls seeing families reconcile after years of tension and others coming together after long periods of distance. The joy on a patient’s face when surrounded by loved ones, laughing and reminiscing, is what it’s all about. “Hospice care, at its core, is about human connection.”

Hoffmann Hospice to host Grief Support Camp for Children of first responders KGET Bakersfield, California; by Jaspreet Multani; 8/29/24 Hoffmann Hospice will host its second annual free grief support camp for children and teens of first responders on Saturday, Sept 14, 2024. The event called “A Heart for Hero’s Art Camp,” provides a safe space for young people grieving the loss of a loved one such as a parent, sibling, or grandparent. ...  Led by experienced grief counselors, the camp offers therapeutic activities and support to help children express their grief in a nurturing environment. ... “We have a huge heart for kids, especially those who put themselves on the line for us every day,” said Ryan D’ Amato of Hoffmann Hospice.Editor's Note: While many hospices provide excellent grief camps for children and teens, this one stands out for tending the unique experiences for families of first responders. Many of these deaths will have been sudden and tragic--without hospice care--and often more complex to grasp and grieve. Hoffman Hospice's website indicates support for other non-hospice deaths: Miscarriage, Still Birth or Sudden Loss; Suicide. Bravo and thank you to Hoffman Hospice and other hospices who utilize your grief services to support your larger communities through often-disenfranchised deaths and grief.

The DEI Dilemma: Separate teams or embedded methods? Clinical Leader; by Denise N. Bronner, PhD; 8/28/24 In recent years, diversity, equity, and inclusion (DEI) has become a focal point in many industries, with the pharma sector being no exception. As political forces shift the societal climate to be increasingly DEI-averse, pharma sponsors face critical decisions regarding the implementation of DEI initiatives: Should DEI efforts be managed by a separate, dedicated DEI team or woven into the fabric of existing processes and departments? To answer that question, we must examine the advantages and drawbacks of both strategies, focusing on key factors like resource allocation, implementation efficiency, cultural integration, and the long-term impact on trial inclusivity. ... Integrating DEI into all aspects of a business is a complex task that requires careful planning and coordination. Without a clear strategy, efforts can become fragmented and ineffective.Editor's Note: While this DEI discussion is written to the pharma industry, its DEI structures, strategies and outcomes apply to hospice and palliative care services. 

CareXM and Enhabit increase clinician capacity by 250% using virtual visits amid staffing shortages GlobeNewswire; by CareXM; 8/27/24 CareXM ... is proud to announce  some of the exciting results with Enhabit in their quick connect Virtual Visits platform. ... “We saw an increase in clinician capacity, allowing us to do more with less,” says Vice President of Care Management Shelley Baker of Enhabit, which provides care annually to 228,000 patients. “Completing visits virtually, when appropriate, has freed up our clinicians to better manage their schedules so they can be with patients who need hands-on care.” "While virtual visits do not replace the need for in-home visits, they do offer the ability to connect with patients more frequently, supplementing the visits that do need to be in-person,” said Si Luo, CEO at CareXM, “We see a growing need not just for visit utilization but for visit prioritization- let’s save our field nurses for those visits that truly do need to be in-person. ..."

Bridgeway Hospice’s new nonprofit ensures access to care Hays Free Press, Buda, TX; by Megan Navarro; 8/21/24 To ensure that members of the community have ease of access to the care that they need, a new nonprofit has been established out of a local hospice service in Buda: Bridgeway To Care Foundation. “We’ve had the hospice for three years — Bridgeway Hospice — and then we have our home health, which is Be Healthy At Home; we established that in 2008. We just saw a certain number of clients that are going without care or kind of falling in between either Medicare age or not being able to utilize their hospice benefit, whether because they’re [younger] than 65 or they’re continuing to seek treatment, such as chemotherapy,” said Brandis Wilmore, president of Bridgeway Hospice. 

Bereaved parent preferences on quality end-of-life care for children with cancer in the South Cancer - American Cancer Society; by Isaac Martinez BA, Erin Currie PhD, RN, Elizabeth S. Davis MS, Rohail Kumar MD, Valerie Lawhon MS, ALC, NCC, Jennifer M. Snaman MD, Raba B. Tefera BA, Smita Bhatia MD, MPH, Abby R. Rosenberg MD, MS, MA, Emily E. Johnston MD, MS; 8/18/24 The authors sought to understand bereaved family preferences for end-of-life (EOL) care, particularly among Black families and those in the South. ... Family decision-making involved maintaining hope, not causing harm, doing what was best for their child and themselves, and religious beliefs. There was no clear preference for home versus hospital death (3.0 [1.8–4.0]). Instead, parents considered their child’s desires and/or medical needs, siblings, and prior experiences with death. To have a comfortable death, parents highlighted the need for comprehensive education about their child’s EOL, a caring and comfortable environment, and 24/7 access to their care team. Families expressed a dual preference for comfort care ... and chemotherapy ... at EOL.

Hospice care for those with dementia falls far short of meeting people’s needs at the end of life University of Michigan; by Maria J. Silveira; 8/18/24 ... Strikingly, only 12% of Americans with dementia ever enroll in hospice. Among those who do, one-third are near death. This is in stark contrast to the cancer population: Patients over 60 with cancer enroll in hospice 70% of the time. In my experience caring for dementia patients, the underuse of hospice by dementia patients has more to do with how hospice is structured and paid for in the U.S. than it does patient preference or differences between cancer and dementia. ... In the U.S., ... Medicare’s rules and regulations make it hard for dementia patients to qualify for hospice when they and their families need support the most – long before death. In Canada, where hospice is structured entirely differently, 39% of dementia patients receive hospice care in the last year of life. ...

Capitalizing palliative care startups Hospice News; by Jesse Floyd; 8/14/24 As a sector, most standalone palliative care providers are still maturing from startups into long-term, sustainable businesses. ... This means gathering the necessary startup capital to take a new palliative care provider from idea to execution is often the first tangible goal for hopeful entrants into the space. When Jonathan Fluhart and Tiffany Hughes set about getting PalliCare, their Texarkana, Texas-based palliative care provider from theory to reality, they ran headlong into this obstacle. ... “Initially, what we thought we would do is build a palliative program that would nest between the home health and hospice,” Fluhart said. “We started to go into the community to talk with facilities and places that we felt would benefit from our services. Once they learned that we were tied to a home health provider, especially a hospice, it turned them off.” They decided the answer was two-fold: Sever ties with the hospice care provider they worked for; then start casting about for investors. ... 

Commentary: Prognostication in Alzheimer's disease and related dementias Journal of the American Geriatrics Society / Early View; by Natalie C. Ernecoff PhD, MPH, Kathryn L. Wessell MPH, Laura C. Hanson MD, MPH; 8/8/24  ... Hospice provides comfort-oriented care, emphasizing patient-tailored elements of quality of life, including time with family, access to nature, and music. In late-stage ADRD, studies show that a majority of families prioritize comfort-oriented treatment, and understanding prognosis may help them align treatments accordingly. Yet, only 15% of people enrolled in hospice with a primary diagnosis of ADRD. This is due to difficulty estimating 6-month prognosis required for hospice eligibility—ADRD carries a prognosis of 12–18 months in the latest stage. While low rates of live discharges from hospice are a regulatory requirement for hospices, people who are increasingly experiencing ADRD progression lose access to those beneficial hospice services. ...

The tangled web of pediatric palliative care payment and policy Hospice News; by Holly Vossel; 8/13/24 A complex web of state regulations and reimbursement systems can challenge pediatric palliative care access for seriously ill children and their families. The nation’s fragmented health care system lacks clear guidance when it comes to navigating chronic, complex conditions in children, adolescents and young adults, according to Jonathan Cottor, CEO and founder of the National Center for Pediatric Palliative Care Homes. Much of the current state palliative regulations and reimbursement pathways focus on adult patient populations, representing a significant barrier to improved quality and support in the pediatric realm, Cottor said.

Examining the relationship between rural and urban clinicians’ familiarity with patients and families and their comfort with palliative and end-of-life care communication

Hospices leverage community resources to serve vulnerable homeless populations Hospice News; by Holly Vossel; 8/13/24 Hospices are increasingly collaborating with community organizations to better address the end-of-life needs of the homeless population. Isolated homeless senior populations are reaching concerning levels nationwide. Many medical and nonmedical issues can be exacerbated at the end of life among unhoused and homeless seniors compared to others, according to James Patrick Hall, executive director of Rocky Mountain Refuge. The Denver-based nonprofit organization offers shelter for people with end-of-life care needs. ... Homeless populations have increased across the country in recent years, with seniors among those reaching “record-high” volumes and outpacing other demographic groups, Harvard University’s Joint Center for Housing Studies research recently reported. Editor's Note: For data specific to your state, click here for The U.S. Department of Housing and Urban Development's "The 2023 Annual Homelessness Assessment Report (AHAR) to Congress."

ETC model is failing to boost home dialysis utilization, nephrologists say McKnights Home Care; by Adam Healy; 8/9/24 Nephrologists are worried that the End-Stage Renal Disease Treatment Choices (ETC) model has not made good on its promise to promote home-based kidney care and advance health equity. The Centers for Medicare & Medicaid Services launched the ETC model in 2021, randomly selecting about 30% of providers treating end-stage renal disease for participation. The model uses financial incentives to encourage greater use of home dialysis treatment and increase kidney transplant access. However, these incentives have not been effective in producing their intended results, according to Amit Kapoor, MD, the chief nephrologist at Strive Health. ... A March study published in JAMA found that the ETC model may unintentionally punish providers who serve high-needs, low-income or minority patients.