Literature Review

Raising the standard of Arizona’s dementia care Lovin' Life; by Lin Sue Flood; 9/7/25 Arizona is setting a bold new standard to better support families impacted by dementia. A groundbreaking state mandate requires all memory care facilities to provide up to 12 hours of specialized dementia training to their staff, plus four hours of continuing education each year. This extensive training combines online video modules with hands-on, in-person skills sessions. Hospice of the Valley’s experienced Dementia Team is leading the way as one of the agencies the Arizona Department of Health Services has approved to deliver this comprehensive training. The nonprofit organization is unique in offering it as a free community service.

Do not resuscitate (DNR) emergency medical services (EMS) protocol variation in the United StatesThe American Journal of Emergency Medicine; by Amelia M Breyre, E Jane Merkle-Scotland, David H Yang, Kenneth Hanson, Sameer Jagani, Abe Tolkoff, Satheesh Gunaga; 7/25Do Not Resuscitate (DNR) orders are essential for ensuring that critically ill patients receive care from Emergency Medical Service (EMS) aligned with their preferences. However, significant variations exist in EMS protocols regarding acceptable DNR documentation leading to discordant care, moral distress, and ethical dilemmas. Although most EMS protocols have dedicated DNR protocols, this is not universal and there is significant variability in types of documentation recognized as valid. Documentation that is concise, portable, and designed for EMS use, such as the POLST is preferred. Assistant Editor's note: It is this variability in protocols that personally scares many of us who work in the EOL field. It is not uncommon to hear a hospice/palliative worker joke that they want a "DNR tatoo on their chest"! Perhaps it would be easier (and less painful) to continue to promote POLST, or something similar, in each of our respective workplaces.

This test tells you more about your heart attack risk KFF Health News; by Paula Span; 8/1/25 A long list of Lynda Hollander’s paternal relatives had heart disease, and several had undergone major surgeries. ... A cardiologist told Hollander that based on factors like age, sex, cholesterol, and blood pressure, she faced a moderate risk of a major cardiac event, like a heart attack, within the next 10 years. ... Her doctor explained that a coronary artery calcium test, ... could provide a more precise estimate of her risk of atherosclerotic heart disease. “The test is used by more people every year,” said Michael Blaha, co-director of the preventive cardiology program at Johns Hopkins University. Calcium scans quadrupled from 2006 to 2017, his research team reported, and Google searches for related terms have risen even more sharply. Yet “it’s still being underused compared to its value,” he said. One reason is that although the test is comparatively inexpensive ...Editor's Note: Good news. This test predicts and protects heart health, potentially providing extra years of good (or at least better) quality of life. Bad news. It is "being underused compared to its value," partly because "the test is comparatively inexpensive"? Bad news. What does the low-cost factor say ethics, choices, and quality of life? Good news. Because of my family's cardiac history, my physician recently recommended I take this test. I did, and received great results! I move into the future with greater confidence, less fear, and more gratitude for the some 100,00 heartbeats we each experience, each day.

Bipartisan bill offers ‘meaningful’ immigration reform that could help address senior living workforce needs, leaders say McKnights Senior Living; by Kimberly Bonvissuto; 7/1/25 A bipartisan immigration reform bill proposing a pathway to legal resident status for certain undocumented immigrants — including direct care workers — is earning the support of the senior living and care industry. The recently re-introduced Dignity Act of 2025 “offers the solution to our immigration crisis: secure the border, stop illegal immigration and provide an earned opportunity for long-term immigrants to stay here and work,” sponsor Rep. Maria Elvira Salazar (R-FL) had said in introducing the bill. [Its co-sponsor is] Rep. Veronica Escobar (D-TX).

Where UnitedHealthcare, Humana rule the Medicare Advantage market Modern Healthcare; by Tim Broderick; 7/22/25 Medicare Advantage competition was meager in 97% of counties last year, where beneficiaries could choose among just a handful of dominant insurers. The health policy research institution KFF analyzed Centers for Medicare and Medicaid Services data on the plans available across the U.S. and Puerto Rico in 2024. The findings indicate that Medicare enrollees have few options in most areas. Market share was “highly concentrated” in 79% of counties and “very highly concentrated” in another 18%, KFF found, using metrics similar to those the Federal Trade Commission and the Justice Department employ to measure competitiveness. ... Ninety-three percent of Medicare-eligible people lived in “highly concentrated” or “very highly concentrated” counties. ... [Click here and scroll down for the national map with] the level of Medicare Advantage market concentration for each county and the market share for each county's top insurer.

Post-acute care faces labor shortage amid immigration scrutiny Modern Healthcare, Post-Acute Care; by Diane Eastabrook; 7/23/25 Nursing homes and home care operators are scrambling to find replacements for foreign-born workers no longer eligible to work in the U.S. due to changes in immigration policy. Providers in Boston, Atlanta and other cities with large populations of immigrants, and Haitians in particular, say the loss of foreign-born workers in an already tight job market is making it increasingly difficult to meet the growing demand for care — and will likely drive up care costs. Last month the Homeland Security Department began notifying more than 500,000 Cubans, Haitians, Nicaraguans and Venezuelans that it terminated a Biden-era program that allowed them to live and work in the U.S. It said those who have not attained legal status to remain in the U.S. outside of the program must leave immediately. Despite court challenges, the federal government also aims to end another program in early September that grants temporary protected status to Haitians and Venezuelans who have lived in the U.S. for more than a decade. [Full access might require subscription.]

Rural hospitals eye service expansions to weather federal cuts Modern Healthcare; by Alex Kacik; 7/14/25 Rural hospitals are hopeful they can add rather than reduce services to help soften the blow from looming Medicaid and Medicare cuts. ...  If rural providers cannot recruit physicians, lean more heavily on philanthropic donors or find other ways to reduce their reliance on Medicaid and Medicare reimbursement to get ahead of cuts in the law, hospitals will be forced to pare back services or close their doors, industry observers said. ... In response, rural providers have accelerated ongoing operational adjustments, including renegotiating vendor contracts, beefing up their coding and billing processes, freezing new hires and standardizing daily tasks to reduce administrative waste. But those tweaks alone cannot sustain rural hospitals, so some providers are aiming to grow surgeries, infusions and other services to boost their bottom lines, executives said.

What might the past suggest about rural emergency services amidst critical access hospitals’ decline? AMA Journal of Ethics, American Medical Association; by Siân Lewis-Bevan, MD, MPH, EMT-B and Stephen Powell, MD; July 2025Critical access and other rural hospitals have struggled to remain open, which exacerbates inequity in rural residents’ access to routine and emergency health services and strains already-taxed rural emergency medical services (EMS). This article discusses the recent history of rural hospital closures and their effects on rural emergency care. This article also suggests modifications to EMS policy and practice that could improve rural community members’ access to health services and bolster EMS services in rural areas.

Wisconsin author discusses her mother’s aging, dying in the American health care system: The long-term care system failed both her and her mother, she writes Wisconsin Public Radio; by Colleen Leahy; 6/27/25At age 99, Judy Karofsky’s mother was kicked out of her Wisconsin hospice facility. Within 48 hours of that decision, Karofsky became her mother’s default nurse. “I had to find a wheelchair for her. I had to keep track of her meds. I had to buy all the bandages and supplies that she would [need],” Karofsky told WPR’s “Wisconsin Today.” Karofsky is the author of “Diselderly Conduct: The Flawed Business of Assisted Living and Hospice.” In it, she chronicles nightmare scenarios as her mother aged and died in the American healthcare system: making her way through independent living, six different assisted living facilities, memory care, skilled nursing and hospice.  

Families demand end to Medicare waiting period for early-onset Alzheimer’s patients Washington Examiner; by Elaine Mallon; 6/15/25 Jason Raubach was diagnosed at 50 years old with early-onset Alzheimer’s disease — a diagnosis that affects nearly 200,000 Americans. He received the diagnosis in 2018, completely upending life for his family. His youngest child was just a freshman in high school. ... Shortly before receiving an official diagnosis, Jason Raubach lost his job, having to move his family onto a consolidated omnibus budget reconciliation act health plan, or COBRA plan, which allows a person to keep their health insurance even after losing their job. “It wasn’t cheap,” Elizabeth Raubach said.However, once diagnosed, Jason Raubach had to wait two and a half years before he could receive coverage under Medicare, health insurance for those 65 years and older or those with qualifying disabilities. But Elizabeth Raubach, along with dozens of other caretakers for people diagnosed with Alzheimer’s, called on Congress in a letter to eliminate the 29-month waiting period required for those under the age of 65 to receive coverage under Medicare. ...

A ‘cloak of comfort’: an integrated approach to palliative care for cancer patients Sinai Health; 5/26/25 At Mount Sinai Hospital, palliative care is fully integrated into cancer care, providing comprehensive, person-centered support for those with advanced illness. Palliative care, derived from the Latin pallium meaning “cloak,” offers comfort and support to individuals with serious illnesses. Often misunderstood as solely end-of-life care, it actually provides relief at any stage of a life-threatening illness and can be provided in tandem with cancer treatment. This holistic approach addresses physical, emotional, and spiritual needs, aiming to improve quality of life for both patients and their families. In fact, early integration of palliative care can enhance symptom management, extend life and offer greater support to caregivers. Patients can receive care at Mount Sinai Hospital’s Cancer Care Clinic, at home through the Temmy Latner Centre’s home palliative care program, and in the palliative care unit at Hennick Bridgepoint Hospital.  

Sixteen years with leukemia taught me to savor life Cure; by Michelle Lawrence; 5/21/25 I’ve lived with large granular lymphocytic leukemia for 16 years and have learned to spend my energy wisely, embrace palliative care and choose joy over anger. ... It has been an exhausting journey, but I am blessed to have survived 16 years. ... In the beginning, I didn't care; I told everyone because I was treatment-focused, but now I am focused on quality of life. Cancer has robbed me repeatedly. Peers and family members are married and have careers and families. They plan birthday parties and playdates and worry about their kids’ homework. I celebrate the fact that I could take a shower and get dressed by myself. I grieve for those missed opportunities. ... I have recently, in the past couple of years, transitioned into palliative care, a choice I never dreamed of ever making. ... I am a survivor — I am more than my diagnosis. I am not Michelle, the cancer patient; I am Michelle who has cancer. ...

A dozen seniors at risk of being evicted from assisted living facilities in Stanislaus County NBC KCRA-3, Newman, CA; by Andres Valle; 5/15/25 The closure of two senior residential care facilities in Stanislaus County has left over a dozen older residents, including hospice patients, scrambling to find new homes with just days' notice. This decision comes after the passing of Kelsy Ramos, the licensee of Golden Age Living facilities in Turlock and Newman. Ramos, a Turlock native reported missing earlier this month, was found dead last Monday in Selma. The California Department of Social Services ordered the closure with no licensed manager in place, citing the absence of regulatory oversight.