Literature Review

Palliative care clinicians goals-of-care notes more extensive than other providers’ documentation Hospice News; by Jim Parker; 3/5/25 A team of researchers has developed a standardized goals-of-care note to document patient wishes in the electronic medical record. Many patients do not experience goals-of-care conversations in a timely manner. But even among those who have, their wishes can get lost if they are not documented. The standardized note created by a research team from the Regenstrief Institute, the Indiana University School of Medicine and Indiana University Health can help health care providers be aware of and access patients’ goals of care, according to lead investigator Dr. Alexia Torke. ... The research on the note was published in the American Journal of Medicine.

Breaking bad news: Guidance on disclosing a dementia diagnosis Medscape; by Megan Brooks; 3/3/25 As biomarker testing for Alzheimer’s disease (AD) evolves, timely and compassionate disclosure of a diagnosis is more complex than ever. Yet, clinicians may struggle with how — or in some cases whether — to disclose that a patient has mild cognitive impairment (MCI) or dementia. A recent perspective offers a practical roadmap to help clinicians navigate these challenging conversations. The authors from the Perelman School of Medicine, University of Pennsylvania, Philadelphia, noted that disclosure of a dementia diagnosis “is particularly nuanced and requires a conscientious approach. Clinicians must assess patients’ understanding and appreciation of symptoms, goals for the evaluation, and desire for information.” 

Measures to prevent and control COVID-19 in skilled nursing facilities-A scoping reviewJAMA Health Forum; Benjamin E. Canter, OTD; Agne Ulyte, MD; Brian E. McGarry, PhD; Michael L. Barnett, MD, MS; 1/25Skilled nursing facilities (SNFs) experienced high mortality during the COVID-19 pandemic, leading them to adopt preventive measures to counteract viral spread. This scoping review identified 16 preventive measures, both nonpharmacologic (eg, staffing, visitor restrictions) and pharmacologic (eg, vaccines, antivirals) interventions. Nonpharmacologic measures were widely implemented but lacked evidence for effectiveness, whereas vaccinations and antivirals showed substantial benefits but were underutilized; up-to-date vaccination status was suboptimal in residents and staff and only a minority of infected residents received antiviral treatment.

Addressing overtreatment in end-of-life cancer care Medscape; by David J. Kerr, CBE, MD, DSc; 2/19/25 ... What do we mean by overtreatment? This means that many patients who are approaching the end of life receive treatments, like directed anticancer therapies, that are unlikely to provide clinically meaningful benefits and may do more harm than good. This is an expression that I use often in the clinic when I'm explaining to patients that we have reached the end of the road in active interventions, such as chemotherapeutic drugs, that will do more harm than good. It doesn't stop us from doing our very best to look after patients. We focus on improving the quality of life and maintaining that for as long as we can, while continuing to care and look after the patients. ... Overtreatment may even, one would argue, accelerate death when you consider those 1% or 2% mortality rates that can be associated with some treatments that we offer. ...

New report details financial, emotional toll of Parkinson’s on family caregivers McKnights Home Care; by Foster Stubbs; 2/4/25 A new report sheds a light on the unique challenges faced by family caregivers who care for loved ones with Parkinson’s disease (PD). The report, Parkinson’s Disease Caregiving in the US, features insights from secondary analysis and supplementary interviews with 10 PD caregivers. These caregivers average 31 hours of unpaid care per week; half of interviewed caregivers exceed 100 hours each week, according to the report. The National Alliance for Caregiving (NAC), with support from The Michael J. Fox Foundation for Parkinson’s Research (MJFF) and Arcadia University, released the report.  

[UK] Identifying challenges related to the management of comorbidities in people with dementia in residential care: Expert delphi consensus exerciseJournal of Applied Gerontology; Serena Sabatini, Frances Hawes, Kelechi Eluigwe, Eugene Y. H. Tang; 1/25Improving early detection, management, and treatment of comorbid conditions to dementia in residential care could slow down cognitive and functional decline, and increase residents’ quality of life. ... Mental illnesses, delirium, and sensory impairments were identified as the most difficult comorbidities to dementia to deal with. Medication management, symptom management, shortage of staff, lack of training among staff, and limited resources from the broader healthcare system were identified as the most difficult issues when dealing with dementia comorbidities. To address disparities between different residential care homes there is the need of mandatory standards of care across UK residential care homes, and of clear guidelines on topics such as pathways of care for residents’ medical problems, staff to resident ratios, and minimum wages.

Grant renews funding for pain and aging center Cornell Chronicle; by Weill Cornell Medicine; 1/30/25 The Translational Research Institute for Pain in Later Life (TRIPLL), a New York City-based center to help older adults prevent and manage pain, has been awarded a five-year, $5 million renewal grant from the National Institute on Aging (NIA). ... The institute seeks to apply insights from psychology, sociology, economics and communications to develop and implement effective pain management techniques that are acceptable to and practical for older adults.

How innovation is changing [hospital] length of stayHealthLeaders; by Eric Wicklund; 1/23/25 Allina Health is using technology and new ideas to reduce the time a patient spends in the hospital. They're seeing improved outcomes, reduced costs and more capacity to treat patients who need to be hospitalized.  One of the key metrics in clinical care is patient length of stay (LOS), traditionally defined as the time between a patient's admittance and discharge from a hospital. ... New technologies like AI and concepts like remote patient monitoring (RPM) and Hospital at Home are helping healthcare executives gain a better understanding of LOS, and in turn they're reducing costs and improving care management.Editor's note: How do these hospital technologies interesect with and impact your referrals for palliative and hospice referrals? For discharges to home health or senior facilities that receive care from your agency?

Healthcare Industry Team 2024 Year in Review JD Supra; by Claire Bass, S. Derek Bauer, Kevin Bradberry, Ernessa Brawley, Sarah Browning, Charlotte Combre, Payal Cramer, Emily Crosby, Vimala Devassy, Shareef Farag, Amy Fouts, Winston Kirton, Caroline Landt, Charlene McGinty, Justin Murphy, Lynn Sessions, Gregory Tanner; 1/22/25As we begin a year that will once again be transformative for the industry, we are excited to present our comprehensive 2024 year-in-review, highlighting all that has happened and the trends that will shape 2025. [Downloadable PDF from BakerHostetler, bakerlaw.com. Large categories include the following:]

Transforming care: Spencer Health Solutions and Pharmerica partner to simplify medication management and improve lives The MarCom Journal, Morrisville, NC; by Leigh White, PharMerica and Daphne Earley, Spencer Health Solutions; 1/21/25In a move set to redefine how medication is managed, Spencer Health Solutions (SHS), a leader in innovative healthcare technology, and PharMerica, one of the nation’s largest and most trusted long-term care pharmacy services provider, are joining forces. This transformative partnership aims to make managing medications easier and more reliable for individuals with complex medication needs, senior living communities, and payers nationwide. ... Spencer Health Solutions (SHS) is dedicated to transforming medication management through innovative healthcare technology. ... PharMerica ... serves the long-term care, senior living, hospital, home infusion, hospice, behavioral, specialty and oncology pharmacy markets. 

Los Angeles wildfires leave older patients vulnerable Direct Relief - California Wildfires; by Talya Meyers; 1/22/25 The radio announcer said nursing home residents were being evacuated to the Pasadena Convention Center, so Dr. Laura Mosqueda headed over. Older adults were arriving at the evacuation shelter with hair and hospital gowns covered in ash. People urgently needed to be on oxygen — in a large convention hall with few electrical outlets — or their catheters were getting full but responders didn’t have gloves. ... Some patients were in hospice and end-of-life care, and getting them placed more comfortably was an urgent priority. ... The wildfires that ripped across Southern California communities this month will hurt the health of millions — causing everything from short-term respiratory symptoms to long-term adverse outcomes from chronic disease — but older adults will likely be among the most vulnerable. ... [And with that,] Dr. Mosqueda cautioned that while older adults may be more likely to be medically fragile, many aren’t. Many have perspectives that help them navigate frightening, uncertain situations like the wildfires. “Older adults…were among the most calm and circumspect people I spoke with,” she recalled. “They just had a lot of wisdom and life experience, and they weren’t getting freaked out. They had so many internal resources.”

The 'paradigm shift’ of hospice service diversification Hospice News; by Holly Vossel; 1/17/25 Some hospices have delved deeper into service diversification to improve timely access and expand their patient reach, while others remain focused on end-of-life care delivery. The decision to launch into new service realms can come with a range of operational and reimbursement questions. Among the keys to diversifying services is establishing a business infrastructure that allows for innovative growth based on communities’ needs, according to Leslie Campbell, COO of Touchstone Communities. The San Antonio, Texas-headquartered company provides hospice, home health, veterans services, assisted living and skilled nursing services. ... Hospice leaders need to ensure that both back-office administrative and interdisciplinary teams are educated on how business growth impacts them, particularly when it comes to quality and compliance across the care continuum, Campbell stated.

Sociodemographic disparities in the use of hospice by U.S. nursing home residents: A systematic reviewAmerican Journal of Hospice and Palliative Medicine; Christine E. DeForge, PhD, RN, CCRN; Hsin S. Ma, MPP, MA; Andrew W. Dick, PhD; Patricia W. Stone, PhD, RN, FAAN, CIC; Gregory N. Orewa, PhD; Lara Dhingra, PhD; Russell Portenoy, MD; Denise D. Quigley, PhD, MA; 1/25 Hospice can improve end-of-life (EOL) outcomes in U.S. nursing homes (NHs). However, only one-third of eligible residents enroll, and substantial variation exists within and across NHs related to resident-, NH-, or community-level factors. Studies adjusting for resident-, NH-, and community-level factors found lower hospice use among male residents, Black/Non-White residents, and residents of rural NHs, with mixed results by payor and ownership. Results were mixed for hospice referral and length-of-stay. These findings suggest complex influences on NH hospice use.