Literature Review

Homebound seniors living alone often slip through health system’s cracks KFF Health News; by Judith Graham; 12/2/24 Carolyn Dickens, 76, was sitting at her dining room table, struggling to catch her breath as her physician looked on with concern. “What’s going on with your breathing?” asked Peter Gliatto, director of Mount Sinai’s Visiting Doctors Program. “I don’t know,” she answered, so softly it was hard to hear. “Going from here to the bathroom or the door, I get really winded. I don’t know when it’s going to be my last breath.” Dickens, a lung cancer survivor, lives in central Harlem, barely getting by. She has serious lung disease and high blood pressure and suffers regular fainting spells. In the past year, she’s fallen several times and dropped to 85 pounds, a dangerously low weight. And she lives alone, without any help — a highly perilous situation. Across the country, about 2 million adults 65 and older are completely or mostly homebound, while an additional 5.5 million seniors can get out only with significant difficulty or assistance. ... It’s a population whose numbers far exceed those living in nursing homes — about 1.2 million — and yet it receives much less attention from policymakers, legislators, and academics who study aging.

Elizabeth Nemacheck: The personal consequences of EPH's discontinuation of in-home hospice Estes Park Trail-Gazette, Estes Park, CO; by Elizabeth Nemacheck; updated 11/22/24 I am writing regarding Estes Park Health's decision to eliminate in-home hospice and home health care in Estes Park. Hospice helps the family by dismantling hospice, Estes Park Health has off-loaded the end-of-life burden solely on the family, during one of the most difficult and totally predictable life events. I hope to illustrate three key issues we identified by sharing my story. My father died at home in September of 2024. After his terminal cancer diagnosis midsummer, my family discussed my dad's wishes in consultation with his oncologist and primary care doctor. Like so many of us, my dad decided that he would very much like to die at home, so that became our goal. We sought alternatives to hospice support beyond Estes Park Health's discontinued home hospice care; once we confirmed that the only hospice available in Estes was in-hospital hospice, we built the infrastructure ourselves to be able to keep my dad at home. Thankfully we had the financial resources to do so, and a lot of gumption. While we were able to keep him at home, we identified three key issues:

People with Parkinson’s Disease (PD) face disproportionate rates of harm in hospital setting  Parkinson's Foundation, New York and Miami; Press Release; 11/18/24 The Parkinson’s Foundation published a new article in the December issue of The Joint Commission Journal on Quality and Patient Safety titled “Protecting Parkinson’s Patients: Hospital Care Standards to Avoid Preventable Harm.” The article identifies sustainable solutions to improve care in the hospital for people with Parkinson’s disease (PD) and details how these solutions may be generalized to develop a practical, disease-agnostic care model for all hospital and health systems that wish to avoid preventable harm. ... People with PD are at increased risk of hospitalization, with more than 300,000 people with PD hospitalized each year. While hospitalized, people with PD face increased risk of preventable harm, including longer hospital stays and deterioration of PD symptoms. Adverse outcomes range from temporary, such as higher rates of delirium, to permanent damage, including higher mortality.

Teen honored with Meritorious Civilian Award after rescuing grandparents in house fire [grandmother in hospice care] Chattanoogan.com, Chattanooga, TN; 11/12/24The Whitfield County Fire Department awarded the Meritorious Civilian Award for Bravery to 15-year-old José Fernando Espinoza on Monday in recognition of his exceptional courage during a house fire on Oct. 19. The award honors civilians who show extraordinary heroism in life-threatening situations, celebrating Fernando’s selfless actions that saved his grandparents. Shortly after midnight on Oct. 19, firefighters were dispatched to a fire on Ricky Drive, where flames had rapidly overtaken the home. Though most of the family managed to escape safely, Fernando’s grandparents remained trapped inside. His grandmother, bedridden and in hospice care, and his grandfather, who chose to stay with the grandmother, were unable to make it out on their own. In an extraordinary display of bravery, Fernando reentered the burning home through a window and, pushing through thick smoke and flames, managed to pull both grandparents to safety.

Elderly man sat with injuries for days after his mobile home burned and collapsed WCBD Charleston, South Carolina; by Tim Renaud; 11/11/24 An elderly Colleton County man sat injured in his yard for days after his mobile home burned and collapsed. Colleton County Fire Rescue said 9-1-1 received a call reporting the fire and injured man around 10 a.m. Friday. Crews arrived to find the single-wide mobile home had already collapsed with the injured man sitting in his yard. The man told firefighters that the home burned down “one or two days ago,” fire rescue said. He suffered burns to his face and hands and was not able to call for help. “He sat injured in the yard since that time,” the agency said. The man’s hospice nurse stopped by to check on him, and that’s when she discovered the fire. She provided initial aid and called 9-1-1. Emergency crews took the elderly man to the burn center at the Medical University of South Carolina for treatment. His condition is unknown. The cause of the fire is under investigation. 

Nurse burnout the root of decreased resident safety, medication errors, study shows McKnights Long-Term Care News; by Zahara Johnson; 11/6/24 A new study has found a direct link between nurse burnout and unfavorable patient and facility outcomes, including medication errors and a degraded safety culture. The meta-analysis of 85 studies and 288,581 nurses, compiling more than 30 years of research, concluded that nurses who suffer from burnout – emotional exhaustion, depersonalization and a low sense of personal accomplishment – have a negative impact on patients.

Bill introduced to increase access to advanced wheelchairs HomeCare, Nashville, TN; 10/24/24 U.S. Senators Marsha Blackburn (R-Tenn) and Tammy Duckworth (D-Ill.) introduced the Choices for Increased Mobility Act (S 5154) to increase access to wheelchairs made with advanced materials by allowing Medicare beneficiaries to upgrade to lighter, more functional wheelchairs without bearing the entire upfront cost. These manual wheelchairs help prevent shoulder injuries, enhance maneuverability and reduce overall pain and fatigue for users. ... When the Medicare billing code for ultra-lightweight manual wheelchairs was established in 1993, materials like titanium and carbon fiber were not considered, as they were not yet in use for wheelchairs. As a result, ... providers have struggled to supply wheelchairs with these advanced materials at the fee schedule amounts set by Medicare.

Michigan HHS to pay $13M after unannounced shooter drill at psych hospital Becker's Hospital Review; by Mariah Taylor; 10/18/24The Michigan Department of Health and Human Services agreed to pay $13 million to settle allegations that it caused psychological damage after conducting a surprise active shooter drill at a children's psychiatric hospital, The Washington Post reported Oct. 17. The Hawthorn Center, based in Northville Township, Mich., is a state-run psychiatric hospital for children with emotional, mood and thought disorders. On Dec. 21, two laborers were instructed by their supervisor to act as armed intruders in an unannounced drill. The two were told to walk around the facility and ensure every room was locked and the people inside were hidden. The receptionist was instructed to announce that there were active shooters in the building and that shots were fired. Neither the staff nor the police were notified a drill was occurring. 911 calls reported the active shooter and 22 police officers rushed to the scene. The two laborers exited the building and were detained while the police sorted out the situation. Employees filed a class action lawsuit in April 2023 against the health department-run facility alleging that the unannounced drill gave them post-traumatic stress and emotional harm. According to the lawsuit, patients acted aggressively toward themselves and others in the subsequent weeks, and staff members experienced increased anxiety and sleep struggles, and some quit their jobs.

Safety first: How to ward off health care facility violence SmartBrief; by Julia M. Johnson; 10/23/24Panelists on an American Hospital Association webinar highlight ways in which hospitals and practices can protect their patients and themselves. ... The American Hospital Association recently hosted a webinar about what hospitals and practices need to know to protect themselves, staff members and patients. “Understanding Origins of Violence in Health Care Facilities” featured Jason Grellner of Evolv Technology and Drew Neckar of Cosecure. Both panelists spoke candidly about technology, terminology and steps that can be taken to dial down the danger at health care facilities.  

Research suggests AI could enhance patient safety, but raises questions The American Journal of Managed Care (AJMC); by Hayden E. Klein; 9/26/24 A new study from Boston University highlighted the potential of generative artificial intelligence (AI) to improve patient safety in health care. Published in The Joint Commission Journal on Quality and Patient Safety, the study tested the widely used AI model GPT-4 on the Certified Professional in Patient Safety (CPPS) exam, where it answered 88% of questions correctly. Researchers believe AI could help reduce medical errors, estimated to cause 400,000 deaths annually, by assisting clinicians in identifying and addressing safety risks in hospitals and clinics. ... The study authors suggested that AI has promise in helping doctors better recognize, address, and prevent mistakes or accidental harm in hospitals and clinics. ... However, the study also highlighted critical limitations of current AI technologies, including the risk of bias, fabricated data, and false confidence in responses. 

Man accused of choking terminally ill wife accepts plea deal KSL.com; by Pat Reavy; 9/27/24 A man who prosecutors say attempted to end his terminally ill wife's life by choking her has accepted a plea deal. DeWayne McCulla, 46, pleaded guilty on Thursday in 5th District Court to an amended charge of attempted manslaughter, a third-degree felony. The charge comes with a domestic violence sentencing enhancement. Arenda Lee McCulla, 47, died on Dec. 21, 2021, following her battle with breast cancer. The night before, however, as a small group of family members were by her side in La Verkin, DeWayne McCulla "choked the victim in an attempt to kill her to ease her suffering while they were with her during her terminal cancer and being on hospice," according to charging documents. Other family members pulled McCulla off of his wife.Editor's note: Crucial information that is not reported in this article: Where was the hospice team in managing this patient's pain? In educating and supporting the caregiver (the husband?) and family about contacting the hospice? In making required visits when the patient is actively dying? In assessing the caregiver's ability to provide care, especially any history or risks of domestic violence, neglect, or abuse? What safety-in-the-home protocols were used by this hospice, especially when hospice team members followed up? Aware of not-knowing these many factors, I do not ask these with judgment but rather to raise awareness of core, preventive measures for other hospice patients.

Injurious fall risk differences among older adults with first-line depression treatmentsJAMA Network Open; Grace Hsin-Min Wang, PharmD, MS; Edward Chia-Cheng Lai, PhD; Amie J. Goodin, PhD; Rachel C. Reise, PharmD, MS; Ronald I. Shorr, MD, MS; Wei-Hsuan Lo-Ciganic, PhD, MS, MSPharm; 8/24One-third of older adults in the US have depression, often treated with psychotherapy and antidepressants. In this cohort study of older Medicare beneficiaries with depression, first-line antidepressants were associated with a decreased FRI risk compared with untreated individuals. These findings provide valuable insights into their safety profiles, aiding clinicians in their consideration for treating depression in older adults.