Literature Review

Kalos Health shutters amid Medicaid changes Hospice News; by Holly Vossel; 10/29/25 Kalos Health Inc. is closing amid changes to Medicaid reimbursement. The change could challenge access to home-based services for chronically ill adults in western New York. The nonprofit provided health insurance coverage across six counties in New York through a Medicaid managed long-term care (MLTC) plan. Since 2014, the plan has coordinated with regional health care providers to serve adults with chronic illness and health disabilities. Kalos Health is part of The Hospice and Palliative Care Group (HPCG), an organization that provides administrative services. Other providers in the group include Niagara Hospice, Liberty Home Care, Hospice of Orleans and The Niagara Hospice Alliance.  

Pulse check: Status update on pediatric palliative and hospice community-based coverageJournal of Palliative Medicine; by Meaghann S Weaver, Alix Ware, Deborah Fisher, Betsy Hawley, Holly Davis, Lisa C Lindley, Steven M Smith, Conrad S P Williams, Tej Chana, Christy Torkildson; 9/25Half (49%) of [the country's surveyed hospice and palliative] organizations reported increasing the number of pediatric patients accepted into their care over the past five years. Programs are less likely to include perinatal (61%) patients compared to infants through young adults (94%). Trauma increased as a reason for pediatric enrollment. Nonmetro geographies are less likely to provide services for children. The pediatric palliative average annual census was 271, and the pediatric hospice average annual census was 74. The pediatric patient's average length of stay for palliative care was 154 days and for hospice was 96 days, [with] Medicaid (47%) [being] ... the most common form of reimbursement. Lack of trained personnel, low referrals, and funding were depicted as the most common barriers.

Telepalliation creates a sense of security: A qualitative study of patients with cancer receiving palliative carePalliative Medicine; by Jarl Voss Andersen Sigaard, Elisabet Dortea Ragnvaldsdóttir Joensen, Una Rósa Birgisdóttir, Helle Spindler, Birthe Dinesen; 10/7/25 ... The aim of this study was to explore patients' experiences with the functionality of the Telepalliation program while receiving specialized palliative care. ... Results: Four key themes emerged: "Sense of coherence," "Telepal platform," "Roles of spouse/partner and relatives," and "Cross-sector collaboration." The program improved patients' sense of security and coherence by enhancing communication with healthcare professionals. ... The platform also successfully integrated relatives into the care process. Editor's Note: While this research was conducted in Denmark, it surely resonates with patient care in the US. Reference articles in the uncertainties of government shutdowns, legislative needs to extend telehealth, and more: 

Stamford-area seniors can now enjoy free daytime care Evergreen, Stamford, CT; by Evergreen Daytime Senior Care and CT Hospice; 10/3/25Thanks to a groundbreaking Medicare initiative, seniors living with dementia now qualify for benefits that help cover the cost of adult daytime care. Designed to improve quality of life, the GUIDE (Guiding an Improved Dementia Experience) Model, offered by Connecticut Hospice's Stand By Me program, features a full range of valuable services, including care coordination, caregiver education, and an annual respite benefit for up to 25 free days at adult day centers like Evergreen Daytime Senior Care. ... "We're excited to partner with Evergreen to provide high-quality adult day services to families enrolled in the GUIDE Model program," explained Mark Olynciw, GUIDE Program Manager at Connecticut Hospice. "Having trusted partners like Evergreen ensures our families have excellent options for their respite benefits."

Shutdown places brakes on hospital-at-home, sending hundreds back to strained hospitals McKnights Home Care; by Adam Healy and Liza Berger; 10/1/25The shutdown of the federal government Wednesday has brought the hospital-at-home program to a screeching halt, resulting in hundreds of patients being discharged from the program or sent to hospitals for continuation of care, stressing an already-taxed healthcare system, providers disclosed to McKnight’s Home Care Daily Pulse. ... Several weeks ago, the Centers for Medicare & Medicaid Services instructed hospital-at-home programs to discharge or return patients to the hospital as of Tuesday. CMS also said it no longer would accept waiver requests for participation in the AHCaH initiative after Sept. 1, 2025. Late Wednesday, CMS announced that it will allow up to 60 days of noncompliance with the AHCaH waiver. 

CMS issues memo with contingency plans for state survey & certification activities in the event of federal government shutdown CMS - Center for Clinical Standards and Quality; by CMS Directors, Quality, Safety & Oversight Group (QSOG) and Survey & Operations Group (SOG); 10/1/25 On October 1, 2025, CMS issued QSO-26-01-ALL identifying State Survey and Certification functions that (a) are not affected by a Federal shutdown, (b) excepted functions that are to be continued in the event of a shutdown (also referred to as “essential functions”), and (c) other activities that are directly affected and therefore should not be operational during a Federal shutdown. CMS also clarified that Hospice Surveys funded through the Consolidated Appropriations Act (CAA) of 2021are considered mandatory and are not impacted by the Federal Government shutdown. Work funded under these sources should continue.

CMS telehealth waivers, virtual hospice re-certification, expire Hospice News; by Jim Parker; 10/1/25 The regulatory flexibilities related to telehealth that the U.S. Centers for Medicare & Medicaid Services (CMS) implemented during the COVID-19 pandemic have expired. This includes the ability of hospices to perform patient re-certification face-to-face encounters via telehealth. Also expiring are waivers that expanded the scope of practitioners eligible to provide telehealth services, as well as flexibilities that removed geographic requirements and expanded originating sites for telehealth services, including or federally qualified health centers and rural health clinics. The government’s failure to extend or make permanent the telehealth re-certification waiver is a “grave mistake,” according to Tom Koutsoumpus, CEO of the National Partnership for Healthcare & Hospice Innovation (NPHI).

End-of-life outcomes and staff visits for hospice recipients residing in assisted living Journal of the American Medical Directors Association; by Wenhan Guo, Shubing Cai, Yue Li, Brian E McGarry, Thomas V Caprio, Helena Temkin-Greener; 9/26/25 Objectives: ... We hypothesized that more frequent staff visits and specific regulatory provisions would be associated with improved EOL outcomes. ... Conclusions and implications: Hospice staffing intensity, especially clinical visits, appears to be associated with EOL outcomes for AL residents. AL state regulations are also associated with hospice quality. These findings underscore the role of both organizational practices and regulatory policy in shaping hospice experiences in AL settings.

Building blocks of hospice family caregiver support Hospice News; by Holly Vossel; 9/24/25 Untapped reimbursement opportunities exist when it comes to developing a sustainable family caregiving infrastructure in the face of rising demand for home-based hospice care. ... Among the payment avenues with potential to improve support for caregivers is the Medicaid-funded Structured Family Caregiving (SFC) program. SFC coverage includes a modest financial stipend to health care providers that offer home- and community-based services for caregivers. ... Roughly 63 million Americans are family caregivers, an increase of nearly 50% since 2015, according to a report from the National Alliance for Caregiving and AARP. About one-in-every-four adults is a caregiver to a family member, with 40% of these individuals providing high-intensity care, the report found. About half of the nation’s caregivers reported negative financial impacts, with one-in-five unable to afford basic needs such as food and 25% taking on debt. Additionally, one-in-five caregivers have poor health outcomes, the report found.Editor's Note: Are you aware that the 2008 CMS Hospice Conditions of Participation identify the "family" 423 times? (Yes, I've searched, counted, and categorized.) Click here for AARP's 2025 edition of Caregiving in the US.

Nursing homes failed to report 43 percent of falls with major injury and hospitalization among their Medicare-enrolled residents HHS-OIG; Report number: OEI-05-24-00180; 9/18/25  

CMS launches landmark $50 billion Rural Health Transformation Program CMS Newsroom - Rural Health; Press Release; 9/15/25 Today [9/15], the Centers for Medicare & Medicaid Services (CMS) unveiled details on how states can apply to receive funding from the $50 billion Rural Health Transformation Program created under the Working Families Tax Cuts Act to strengthen health care across rural America. This unprecedented investment is designed to empower states to transform the existing rural health care infrastructure and build sustainable health care systems that expand access, enhance quality of care, and improve outcomes for patients. ... The Rural Health Transformation Program invites all 50 states to apply for funding to address each state’s specific rural health challenges. 

Heart disease tops US mortality in 2024, CDC reports McKnights Long-Term Care News; by Foster Stubbs; 9/12/25 The leading causes of death in the United States in 2024 were heart disease, cancer and unintentional injury, the Centers for Disease Control and Prevention said in a September report. ... In total, there were 3,072,039 total deaths that occurred in the US in 2024 with a death rate of 722.0 per 100,000 people. This was 3.8% lower than the totals in 2023. Death rates also decreased for all race and ethnicity groups but rates for Black people remain higher than those for all other groups. Overall, death rates were highest for males, older adults and Black people, demonstrating a need for further examination of the health of these demographic groups. Heart disease caused 683,037 deaths, cancer caused 619,812 deaths and unintentional injury resulted in 196,488 deaths. Mortality statistics were collected by The National Center for Health Statistics’ (NCHS) National Vital Statistics System (NVSS) using US death certificate data. [The CDC Report is at Vital Statistics Rapid Release, Number 039, September 2025.]

Perspectives of hospice medical directors on challenges and solutions for improving care for persons living with dementias (PLWD) and their caregiversAmerican Journal of Hospice and Palliative Care; by Taeyoung Park, Abhay Tiwari, Elizabeth Luth, Yongkang Zhang, Simone Prather, Micah Toliver, Giancarlo Chuquitarco, Veerawat Phongtankuel; 8/25A larger proportion of PLWD [persons living with dementia] outlive the 6-month hospice eligibility requirement compared to other terminally ill patients, which leads to high rates of hospice live discharge. Hospice medical directors (HMDs) are physicians with unique insights into both the clinical aspects of care and the administrative and regulatory guidelines of hospice care delivery. To address these challenges, HMDs suggested (1) establishing a dementia-specific hospice program, (2) extending hospice benefit availability for PLWD, and (3) creating a step-down service for families experiencing live discharge from hospice. HMD participants suggested providing additional supports and/or reforming the current Medicare hospice benefits to better address end-of-life care for PLWD, who may require prolonged and intensive end-of-life support.