An Article Explores The Power of Deathbed Visions

• Dr. Christopher Kerr, author of “Death Is But a Dream,” has been interested in deathbed visions since his own experience as a 12-year-old child at the deathbed of his father. New York Times shares about deathbed visions and their meaning and significance. Many examples of real-life visions are shared, and the article explains how researchers are documenting this phenomenon. Helpful to both the dying and those they will leave behind, the article offers a collective insight into these experiences.
• Kerr, Chief Medical Officer and Chief Executive Officer for Hospice & Palliative Care Buffalo, feels he did not choose this intense interest in dying, but that it chose him. At the bedsides of the dying, he has seen the remarkable experience of many who have these visions look “at peace.” The article is filled with reports of these visions, and recounts of the power and meaning of them.
• The article explain the research that Kerr and research fellow Anne Banas began in 2010. They began daily interviews with the 22 patients in the inpatient unit at the hospice campus, hoping to capture frequency and content of these visions. Their research was published in 2014 in Journal of Palliative Medicine.
• Later studies, from numerous other countries confirm that such visions are common. In the last 10 years, Kerr has hired a permanent research team, engaged in expanded studies, and shared what he has learned. His latest focus is on the “emotional transformation” he sees in patients through the experiences of these visions. The paradox is that while dying, he says, “‘They are growing and finding meaning. It highlights what patients are telling us, that they are being put back together.’”
• Kerr says that when he shares at conferences about his researchers he sees “doctors roll their eyes in disbelief,” while “nurses nod their heads in approval.” One of the most amazing things, says Kerr, is the lack of fear of these patients. As they speak of these experiences of their visions, Kerr says,  “‘It highlights the paradox of dying, that while there is physical deterioration, they are growing and finding meaning. It highlights what patients are telling us, that they are being put back together.’”
• The article and an audio link to listen to the article are online at the link below (New York Times, 3/12)

HOSPICE NOTES

NHPCO released a statement supporting CMS’s clarification that a veteran under the Medicare hospice benefit may also receive services not included in the hospice plan of care. (NHPCO, 3/11)

LeadingAge, NHPCO, NAHC and NPHI jointly released results of a survey “that underscores the urgency and need for CMS and Congress to act” to curb troubling hospice irregularities. The survey calls for CMS to target audits on “bad actors,” and for CMS to increase transparency about the outcomes of audits. The groups call for CMS to work on the earlier “34 recommendations” sent to CMS by the groups, and reiterates their hopes of continuing to work with CMS on this (NHPCO, 3/12; LeadingAge, 3/12; NAHC, 3/12: NPHI, 3/12)

“A Fond Farewell: Musings on the End of the Medicare Advantage Hospice Carve-In Demonstration” is a podcast by Husch Blackwell. Noting that this development was a surprise to them, the presenters asked Chris Comeaux, president and CEO of Teleios Collaborative Network, “to share his thoughts on this unexpected turn of events and what may be on the horizon.” The “forward-looking” discussion explores lessons learned, and examines new advocacy ideas for best serving patients. (Husch Blackwell, 3/13)

Hospice and Palliative Care Research and Education (The HAP Foundation) is partnering with the national Child Life Hospice and Palliative Care Network (CLHPN), a professional group for child life specialists working in hospice and palliative care. The partnership will work to increase utilization of hospice and palliative care for seriously ill children.  The efforts will also include “professional development through education, evidence-based collaboration and research” that will be shared among CLHPN members. (The HAP Foundation, 3/25)

“Hospice group pushes for clarity in N.Y. state budget as some warm to for-profit care” is offered on Spectrum News 1 on 3/19.The presentation is in a video newscast of a conversation between Kara Travis, President/CEO of Mountain Valley Hospice and Palliative Care and member of the board of HPCANYS, and Capital Tonight host Susan Arbetter. The conversation focuses on the implications for  NYS’s licensed hospices if Governor Kathy Hochul’s state budget proposal regarding Public Health Law 2805-x waivers is accepted by the state legislature in the final budget. The regulatory waiver in question contains a loophole that allows hospitals, homecare, and physician collaborations, mostly in rural areas, to expand into hospice service areas and circumvent the state’s CON process. New York’s hospices are mostly not-for-profit, and the two existing for-profit hospice providers, says Travis, have a history of good hospice care. However, there is concern the 2805-x loophole would open the floodgate to for-profit hospices to enter the New York market. Advocates maintain that without carefully considering guardrails provided by the CON, there would be a proliferation of bad actors into the end-of-life care space and expose New York to the fraud and abuse pervasive in California, Nevada, and Texas – all states that have allowed market saturation with private equity backed hospices. Governor Kathy Hochul vetoed legislation that would close the door to further for-profit hospice providers as the state faces fraud and abuse scandals in its nursing home industry. Coverage on this issue, also by Spectrum News 1 and Susan Arbetter, continued on 3/22, and explains the history of New York providers relative to this action. In response to reporter questions, says the second link below, “DOH appears to have changed its position.” Cheryl A. Kraus, Director of Government Affairs and Policy for HPCANYS, confirmed that DOH stated publicly after the report that the Department’s intent is to not circumvent applicable CON law, and that any 2805-x waiver application will now require notice and comment. DOH also confirmed the recent waiver collaboration would cease operating until all applicable requirements are fully met.  The article shares more about the various opinions of hospice providers who are most impacted by the state’s recently expanded interpretation of the 2805-x waiver. (Spectrum News 1, 3/19; Spectrum News 1, 3/22)

“The Path to Painless Medication Management” will be offered by Hospice News on April 2. The webinar focuses on “strategies and tactics to help make the medication management process as painless as possible. Featured speakers are from Heart to Heart Hospice and Homecare Homebase. Registration is online at the link below. (Hospice News)

California’s focus on combatting hospice fraud stands out.  California’s Department of Justice (CDOJ) issued a 2021 report about the state’s story of lax oversight. A story in Hospice News reviews the work of the state so far, how other media publications have highlighted the issue, and responses from stakeholders. There are concerns that, in spite of the moratorium on hospice licenses being issued, some hospices have been newly licensed. (Hospice News, 3/13)

McKnight’s Home Care offers “CMS hears you, hospice providers.” Author Lisa Berger, editor of McKnight’s Home Care, calls the abrupt cancellation of the hospice part of the Value-Based Insurance Design Model  “a win for providers – and a clear example of advocacy in action,” and particularly cites national hospice organization’s for helping to “bring down the so-called hospice carve-in of the VBID model.” The program was “rife with problems,” Berger says, adding that innovative hospice models should continue. (McKnight’s Home Care, 3/8)

Congresswoman Michelle Steel, (R-CA), serves on the House Committee on Ways and Means. In a 3/20 hearing with Health and Human Services Secretary Xavier Becerra, Steel addressed Becerra by reporting on hospice fraud and questioning the action of CMS to continue certifying hospices in spite of the moratorium by the state of California. Some information that Steel requested was unavailable to Becerra at the hearing, but he pledged to share more information with her. Becerra shares that he looks forward to working with Steel to address fraud and accountability. Steel specifically addresses other concerns as well. In LA and Orange County alone, Steel notes, CMS approved certification for an additional 98 hospices. A video of the hearing is online at the link below. Steel’s time of interaction with Becerra begins at 4:01 in the video. (YouTube, 3/20)

As a whole, hospices are showing improved quality in providing visits to patients in the last days of life. According to NHPCO, visits from hospices to patients near death rose to 63% in 2021, up from 62%. “While the change is modest, this is the first uptick since the onset of the pandemic, which came with a precipitous drop in these visits.” The article explores the issues, the changes, and examines factors that have impacted the changes. (Hospice News, 3/14)

In a congressional hearing on 3/20, HHS Secretary Xavier Becerra supported telehealth flexibilities becoming permanent. Implemented during the pandemic and planned to expire soon, Becerra calls for making them permanent. Cooperation from states is essential to this happening, says Becerra, and CMS is ready to work in a bipartisan fashion in order to assure a long-term solution. The article at the link below explains more about the efforts to maintain telehealth services. (Hospice News, 3/20)

Low utilization of the Medicare hospice benefit persist among persons of color and, according to an article in Journal for Nurse Practitioners, “increases suffering and aggressive care at the end of life related to social determinants of death.” The article offers tools to address this issue, explores examples of “cultural humility and transformational leadership” in end-of-life care, and offers “considerations in cultural preferences” in advance care planning. (Journal for Nurse Practitioners, 3/6)

PALLIATIVE CARE NOTES

“How Increased Medicare Advantage Transparency Could Impact Palliative Care” appears in Hospice News/Palliative Care News. The article explores both the need for and value of transparency. “Greater transparency within the Medicare Advantage arena could help shed light on palliative care utilization and reimbursement trends taking shape in value-based models,” says Edo Banach, partner at Manatt, Phelps & Phillips LLP. In addition to transparency, says Banach, there is need for greater flexibility and payment incentives. The article offers input from other sources, including NHPCO, and addresses barriers to transparency. (Hospice News/Palliative Care News, 3/12)

“Can We Make More Accurate Prognoses During Last Days of Life?” appears in Journal of Palliative Medicine. The article examines ways to “improve short-term survival prediction in terminally ill patients.” The researchers found that using the methods of Palliative Performance Scale (PPS) and Palliative Prognostic Index (PPI), along with (Short-Term Prognosis Signs (SPS) lead to “a more precise short-term survival prediction across various end-of-life diagnoses.” (Journal Palliative Medicine, 3/8)

The California Health Care Foundation offers “Palliative Care Movement Achieves Significant Progress in California.” A written and video presentation are online at the link below. The report shares about the experiment and growth of a managed care plan in Northern California that strengthened palliative care. Launched as an experiment, the efforts to better support and served seriously ill patients, found a 95% approval by patients. And the “Partnership HealthPlan saved $3 in hospital costs for every $1 spent on palliative care.” Now, palliative care is available to all eligible plan members. The article offers details on the experiment and the current services, gives an elaborate “case for palliative care,” and shares more about palliative care in California. Work remains to be done, and the nature of and need for that work are explored. (CHCF, 3/19)

Seven nonprofit hospice providers in Texas have “launched a palliative care organization branded as Integrity Care Partners.” The combined service are of 73 Texas counties, with plans for additional expansion in the future, will work to cover the “gap in care” between “the care a patient is getting from their primary care or specialist physicians and when they get to hospice.” These are patients are not yet appropriate for hospice services, but who need greater  support for them as they manage serious illness. (Hospice News, 3/22)

END-OF-LIFE NOTES

In “I Asked My Mom if She Was Prepared to Die,” writer and filmmaker Shaina Feinberg shares and reflects on her interaction with her mother when she asked this question. The personal reflection is offered in text and question trees, notes key points about preparing for death, and talks about funerals, wills, and other issues that are faced during these discussions. (New York Times, 3/16)

More Oregonians are seeking  access to aid in dying. An article in Oregonian says, “The Oregon Health Authority reported that 367 people used prescriptions to die under the law, up for 304 in 2022.” Additionally more people received prescriptions, with that number rising from 433 in 2022 to 560 in 2023.  Some of this increase, says the article, may be due to the fact that Oregon’s legislature decided last year to remove the requirement that access to the aid is only available to Oregon residents. In 203, “At least 23 people died who were not Oregon residents,” say health officials. Ages of those utilizing aid in dying range from 29 to 102. (Oregonian, 3/21)

Several states are having ongoing discussions about medical aid in dying. Illinois, West Virginia and Minnesota updates are offered in the articles below. (The Center Square, 3/13, go together; Ballotpedia, 3/13; CBS News, 3/13)

GRIEF AND ADVANCE CARE PLANNING NOTE

Your Tango shares an article that offers a dying physician’s reflection of three things that we should think about as we prepare for death. The patient is a physician who opens up about her experiences and gives advice to others. First, she suggests, visit with an estate lawyer and write a will. This will help to clarify your wishes and strengthen the chances that these wishes will be honored. Next, she suggests, create a record of “bank accounts, debts, and assets.” This will make matters much easier for your loved ones when you die. Finally, she says, “Have open and honest discussions with loved ones about end-of-life care.” The sharing on TikTok also includes “how she navigates the issue on an emotional level.” She shares her own practices to stay present in her life each moment. Offering gratitude and working with a counselor are engagements that help her. (Your Tango, 3/12)

OTHER NOTES

A new report on private equity in home care and hospice is the subject of an article in McKnight’s Home Care. The article, found at the link below, examines this “‘troubling;’ trend. (McKnight’s Home Care, 3/14)

Amy Ettinger, who is dying with incurable cancer, shares her story in “I have a little time left. I hope my goodbye inspires you.” The perspective article appears in Washington Post. She shares about her illness, her participation in a clinical trial, her daily life, and her worsening health. Her desire for her remaining time is to “focus my limited time and energy on doing the things I love with the people I care most about.” (Washington Post, 3/9)

MedPAC, in its March 2024 report to Congress, recommended that Congress cut FFS for Medicare home health providers, arguing that margins are too high and that providers are being generally overpaid. An article in Home Health Care News says that staffing issues are a continuing concern for home health provider organization, and shares why the data used by MedPAC is not fully accurate. The recommendation to Congress is to cut Medicare base payment for home care by 7%. (Home Health Care News, 3/15)

Thanks to Sheila Clark for contributions.

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Hospice Analytics is the national sponsor of Hospice News Network for 2024. Hospice Analytics is an information-sharing research organization whose mission is to improve hospice utilization and access to quality end-of- life care. For additional information, please call Dr. Cordt Kassner, CEO, at 719-209-1237 or see www.HospiceAnalytics.com.