In The News

A Hospice Waiting List?

BK Books

I just read an article that due to the nursing shortage many hospices are unable to accept new referrals and are putting people on a waiting list. Really? A waiting list? I appreciate if there isn’t staff, then there isn’t staff, but a waiting list seems incongruous with end of life. Particularly since most people wait until a person is literally on death’s door before reaching out to hospice.

What to do, you ask? Here are some of my thoughts:

Give written literature as to signs of approaching death and what to do as it approaches for the family. Yes, give Gone From My Sight and The Eleventh Hour as a “I’m sorry we can’t bring you on service right now but these will help you” gift. Giving these learning tools is at least not leaving these families unguided (it's also good PR).

Offer a one-time meeting with the hospice social worker to offer guidance in community resources and support. Write it off as part of your community service, even marketing. The family will either remember you as a hospice that had no room in the inn or a hospice that offered guidance even though there was no room.

Can you discharge some of the patients with dementia that are not declining, that are probably many months from death, to accept those patients who are closer to death?

As during the lockdown times of covid when you used the telephone more as your means of contact, begin using the phone for visit assessments. Have a nurse in the office make calls to patient’s families, touching base when nurses are in short supply…

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Changing Healthcare Costs as a Result of COVID-19 PHE and the Aftermath

The Health Group

Many healthcare providers, consultants to the healthcare industry, and other observers have been attempting to gain an understanding of the changes to the healthcare delivery systems and the changes in costs incurred by healthcare providers, which may have been coming but were stimulated by the COVID 19 PHE.  There is little doubt that nursing costs, like other healthcare costs, incurred by healthcare providers will never return to pre-COVID-19 PHE levels.

The healthcare industry has been significantly impacted, in many geographies and among many provider types, by an increasing shortage of healthcare professionals; however, the shortage, especially in nursing personnel, has significantly increased patient care costs.  Increasingly, nursing personnel are leaving the direct patient care delivery system.  Sign-up bonuses, service continuation bonuses, increased salary and hourly rates, and contracting with staffing agencies, including travel nursing agencies, has become the norm if the healthcare providers want to maintain sufficient personnel to provide patient services.  Currently, many providers cannot, given revenue constraints, even consider contracting with outside agencies for nursing personnel due to the rates being demanded by these outside agencies.  Provider Relief Funding (stimulus monies) and PPP loans, which were eventually forgiven, proved critical for many providers during 2020 and 2021.  Of course, the government cannot continue to make this funding available indefinitely.

A bipartisan letter signed by lawmakers across the country, located here, is seeking an investigation into potential inflated rates for nursing personnel, thereby taking advantage of the current shortage of nursing personnel which has been compounded by the Public Health Emergency.  The letter seeks to determine if inflated rates charged by nurse staffing agencies violate consumer protection laws.

Of course, nurses have been, and continue to be, critical to the delivery of healthcare services regardless of whether they provide services in hospitals, nursing homes, home health agencies, hospitals, or other healthcare environments.  Many nurses and other healthcare professionals will take part in the United Nurses March scheduled for May 12, 2022, in Washington, D.C.

Interesting reading is available at:

There is little doubt that the shortage of healthcare professionals will not be eliminated soon, regardless of the efforts undertaken.  Nursing costs, and other healthcare costs, will continue to rise even after the COVID-19 PHE, and, accordingly, receive increased attention. Healthcare payors, including Medicare and Medicaid, will have to increase or alter reimbursement to healthcare providers to cover the increased cost of services or witness a reduction in the quality of care to patients.  Employers and employees face higher health insurance premiums to offset the increased cost of healthcare services provided to health plan enrollees.

 

VA to Expand Home and Community Based Services by 2026

By NAHC

The Department of Veterans Affairs’ Office of Geriatrics and Extended Care is expanding its Home-Based Primary CareMedical Foster Home and Veteran-Directed Care programs to make them available at all VA medical centers (VAMC) by the end of fiscal year 2026.

VA will add 58 medical foster homes and 70 Veteran-directed care programs to VAMCs  across the nation and add 75 home-based primary care teams to areas with the highest unmet need.

“These evidence-based programs allow Veterans to age-in-place, avoid or delay nursing home placement and choose the care environment that aligns most with their care needs, preferences and goals,” said Executive Director of VA Office of Geriatrics and Extended Care Scotte Hartronft, M.D. “Veterans using these programs have experienced fewer hospitalizations and emergency department visits, reduced hospital and nursing home days and fewer nursing home readmissions and inpatient complications.”

According to VA’s Policy Analysis and Forecasting Office, the number of Veterans of all ages who are eligible for nursing home care is estimated to expand from approximately 2 million Veterans in 2019 to more than 4 million by 2039. As this population grows, VA remains steadfast in providing the highest levels of care to Veterans in the least-restrictive settings.

These programs provide an in-home or smaller care setting than traditional institutionalized long-term care. This smaller setting of care supports less risk of transmission of COVID and other infectious diseases. Many Veterans have chosen these programs instead of institutionalized care during the pandemic for more flexibility in care preferences and less risk of COVID transmission.

 

When Support is Needed at Home or Close to Home

VA offers a wide range of Home and Community Services for older Veterans and those with extended care needs. Visit va.gov/Geriatrics to learn about these services:

VA’s Geriatrics and Extended Care team is dedicated to helping you and your family caregivers connect with the right resources throughout your health care journey. Talk with a social worker at a VA Medical Center or Community-Based Outpatient Clinic near you.

Looking ahead, the number of Veterans of all ages who are eligible for nursing home care is estimated to expand from about 2 million Veterans now to about 4 million Veterans by 2039. As this population grows, VA remains steadfast in providing the highest levels of care to Veterans in the least restrictive settings, with plans to expand the Home Based Primary Care, Medical Foster Home and Veteran-Directed Care programs to all VA medical centers by the end of fiscal year 2026.  

To learn more about services and resources for Veterans and their caregivers, visit www.va.gov/Geriatrics.

 

National Institute for Health Care Management (NIHCM) Q&A: Cutting Through COVID Confusion

More than 900,000 Americans have died from COVID-19, and while new cases have declined in the past week, deaths increased. As the world continues to grapple with COVID-19, questions remain about the future of the virus and what endemic means. Here’s the latest news on common concerns: 

Q: When can children under five get vaccinated?
A: Infants as young as six months could be vaccinated in the next few weeks, depending on the Food and Drug Administration’s (FDA) review of Pfizer-BioNTech’s application for authorization of the vaccine for this age group. 

Q: What do we know about the new variant?
A: The emerging BA.2 sub-variant of omicron has replaced the original strain in many countries and is detected in more than half of the states. BA.2 does not appear to cause greater disease severity but a study from Denmark found it to be 33% more likely to infect others compared to BA.1.

Q: How effective are boosters? 
A: Fully vaccinated people are 14 times less likely to die from COVID-19 than unvaccinated individuals. People with boosters are 97 times less likely to die of the virus. Yet, 51% of eligible Americans have not received their booster dose. New data from the Centers for Disease Control and Prevention (CDC) shows that booster doses are most beneficial to older adults.

Q: Is omicron really that bad?
A: Even though omicron cases are often milder than earlier variants and there is less risk of being admitted to the intensive care unit than during previous waves, the high volume of hospital admissions is straining the health care system. Additionally, many hospitalized patients come in for other reasons and incidentally test positive for COVID. Omicron is not as mild for people with underlying conditions and may cause 50,000 to 300,000 more deaths by mid-March. Some people are deliberately trying to get omicron but learn the reasons why experts say that is a bad idea

Q: What have we learned about Long COVID?
A: New research on factors that may increase the risk for Long COVID includes one study that suggests four biological factors, such as type 2 diabetes or certain autoimmune conditions, could be identified early in a person’s COVID-19 infection. Another study hints that a blood test may be able to predict Long COVID.

Q: What’s the latest on COVID-19 treatments?
A: 
There are several therapeutic options for people who have gotten COVID-19. However, there are not enough of these drugs, and some patients are left untreated. Learn more about the challenges of Remdesivir and the federal contract for Paxlovid.

 
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