Literature Review

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.

Filling the gaps with the loss of Wilshire Health and Community Services NBC KSBY-6, California's Central Coast; by Dylan Foreman; 7/22/25 At the end of June, the longtime medical service provider Wilshire Health and Community Services, which offered everything from hospice and home health care to community services like counseling and transportation, closed its doors, leaving clients looking for help elsewhere. ... [Services] like home health and hospice care are being transferred over to organizations like Dignity Health Home Health and Hospice Care, getting 50% of the patients from Wilshire and sending offers out to 30% of their staff. According to Wilshire, on any given day, they could have at least 250 clients.

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. 

‘Surprisingly hopeful’ story emerges about LGBTQ+ rights, efforts in senior living McKnights Senior Living; by Kimberly Bonvissuto; 5/14/25 ... The Human Rights Campaign Foundation and LGBTQ+ elder advocacy group SAGE on Tuesday released its 2025 Long-Term Care Equality Index, a national benchmarking tool focused on LGBTQ+ inclusion in senior living and care. The key takeaway, the organizations said, is the “defiant progress” occurring despite political attacks against inclusion efforts.  As cuts to the Medicaid program — which many LGBTQ+ older adults rely on — come more into focus, participation in the latest survey jumped 37% from the 2023 report, with 274 long-term care settings across 33 states expressing commitment to inclusive care for more than 29,000 residents and 18,000 staff members. Participants included independent living, assisted living, memory care, continuing care retirement / life plan and affordable housing communities, as well as skilled nursing facilities and hospice settings.

Roughly 40 percent of nurses plan to leave profession within 5 years, survey finds McKnights Home Care; by Adam Healy; 5/13/25 The nursing workforce today is more stable than it was during the height of the COVID-19 pandemic, but a significant share of nurses still plan to leave the profession behind in the next five years, according to the 2024 National Nursing Workforce Survey published in the Journal of Nursing Regulation. ... Approximately 40% of RNs, LPNs and LVNs surveyed said that they planned to leave nursing sometime in the next five years. In 2022, roughly 26% of nurses said the same. The most common reasons nurses cited for wanting to leave their jobs included retirement, stress or burnout, workloads and pressures caused by understaffing, the report noted.

'Patients just get violent' | Louisville healthcare workers describe attacks on the job, calling it a crisis ABC WHAS-11, Louisville, KY; by Shay McAlister, Joseph Garcia, Phillip Murrell, and MIchelle Zelli Right now Louisville’s nursing community is facing a crisis, saying they are under attack while on the job.  Since March, police have been called to three different Louisville hospitals after a nurse was assaulted. But those are only the attacks that are reported, several nurses told WHAS11 they face dangerous situations daily without the necessary support. ... The three incidents of violence against nurses sit on a map of hundreds of crimes reported at or near Louisville hospitals and nearby parking garages over the last year. According to LMPD’s crime data portal, 17 assaults were reported at Norton Hospital, 10 at Jewish Hospital, and 28 at the UofL Hospital parking garage over the last 12 months. ... “Many healthcare professionals that are harmed don't report it, and they don't report it because they don't think anybody will listen. And then there are others who think that it's part of the job. It is not part of the job,” CEO of the Kentucky Nurses Association Delanor Manson said. In 2023, Manson worked with lawmakers to formalize language requiring healthcare facilities to track incidents of violence and implement violence prevention strategies. It's a crisis for the career field.