In The News

Do Families Want Hospice Present During the Death?

By Barbara Karnes

Recently I have been hearing discussion of why families and significant others do not want hospice or EOL Doulas with them during the final moments of life. Families often do not want anyone with them as their special person is actively dying. That is alone, private time. Anyone else present is an intrusion, an invasion of privacy.

My two cents: Yes, some may think it is a very private moment and do not want to share it with "strangers." HOWEVER, most people don’t understand how death happens. They don’t understand how people die. Movies tend to be today’s role model and that is not how death comes. So, most people don’t know what they are getting into when they say they want to be alone.

Education about what dying is going to look like is paramount for us end of life workers. This is the most important thing we give to families and significant others. We need to explain the way most people die — especially the not-so-pretty parts. This includes the sounds, movements, pees, poops, frowns, grimaces, and the struggles that accompany approaching death.

After the "talk," offer to be a presence with them -- at that point it is their choice. Explain how you can guide and support everyone during this special time. You can be quiet & unseen, or have more of a presence if that is wanted. You can be a quiet "conductor."

If after you have explained what will occur and your offer is not accepted, know you have done your job. You have educated and offered support.

Don’t just assume a family wants to be alone. Most families welcome the support and guidance of a professional being with them.

Part of end of life work is to develop a relationship with the patient and family. Work with the dying is more about the emotional connection from which trust can develop than just meeting the physical needs of the patient.  When hospice sends a different nurse, home health aide, social worker, or chaplain on every visit, a bond and trust is not established. A huge part of end of life work is creating a connection and trust during a very emotional time in the family's and patient's lives.

A side note: when my husband was dying last year, my hospice nurse was present. She was invisible but present. She was a great "security blanket" for us even though I knew everything that was going to happen. I had no fear and I had the knowledge. BUT my husband was dying and Stephanie’s presence was a great comfort.

I believe that most families, when death has come, appreciate the knowing presence that end of life workers bring.
 

How Trump Could Roll Back Biden-Era Healthcare Regulations

Fierce Healthcare /By  Noah Tong Dec 6, 2024 3:40pm
 
President-elect Donald Trump and his allies make no secret of their disdain toward federal agencies and their desire to fundamentally disrupt the regulatory state.

The new administration plans to rely on unorthodox health official picks Robert F. Kennedy Jr. and Dr. Mehmet Oz to shape, and remake, healthcare in Trump’s second term, but administrative law experts and health policy analysts expect Trump’s disdain for the prior Oval Office-holder will mirror his first term.

Although many question marks remain as to what healthcare priorities will ultimately catch on, it’s expected Trump will try to reverse Biden-era regulations, as he did during his first term.

That’s where the possibilities unfold.

One avenue for quick recissions of federal rules is through the Congressional Review Act (CRA). The lesser-known federal law enacted during President Bill Clinton’s term allows Congress a short window to overturn final rules with the support of the president.

Lawmakers introduce resolutions of disapproval frequently, but the law is typically a nonfactor except under unique circumstances. After an election when one party is in control of Congress and the White House, the new president has a short time frame to reverse individual rules under the “lookback” period. In 2017, Trump repealed 16 rules, by far the most of any president. Biden followed suit with a few revoked regulations when he took office.

Now, with the executive and legislative branch under Republican rule, Trump will have the opportunity to utilize the CRA once again. He could, theoretically, reverse any rule finalized after Aug. 1, though that date is yet to be determined and certain restrictions may disincentive this behavior…

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Notice of Retraction: Final OASIS E-1 Manual and Change Table

The Final OASIS E-1 Manual and Change Table was posted on the HH QRP Spotlight and Announcement Page last week and removed shortly afterward. CMS reports that the materials are being temporarily removed and will be reposted at a later date.  They will provide an updated announcement once the resources are available. 
 

CMS Approves Revised Home Health Change of Care Notice

Alliance Daily

The Office of Management and Budget (OMB) has approved the Home Health Change of Care Notice (HHCCN) for 3 years. There were no substantive changes made to the HHCCN form or the form instructions. CMS did make plain language and information design changes to the form and form instructions according to our Office of Communications (OC) recommendations. OC’s recommendations in plain language and information design are research-based best practices. The OC worked to apply the same research-based standards across all products and channels to make sure our language, messaging and branding are consistent.

CMS has also provided the HHCCN in 3 additional languages with this package approval.  Those languages, along with English and Spanish, include Chinese, Vietnamese and Korean.  

Since the current HHCCN does not expire until 12/31/2024, you may continue to use the HHCCN (OMB expiration date of 12/31/2024) until 1/31/2025 however, you will be required to use the newly approved HHCCN (OMB expiration date of 11/30/2027) on 2/1/2025.  The newly OMB approved HHCCN form (expiration date of 11/30/2027) may be found in the downloads section.  FFS HHCCN | CMS
 

Hidden Changes: What Home Health Providers May Have Missed In The Final Rule

Home Health Care News / By Audrie Martin

On Nov. 1, the Centers for Medicare & Medicaid Services (CMS) issued the final home health payment rule for 2025, updating Medicare policies and rates for home health agencies. 

But while the payment-related information grabbed headlines, there are plenty of other changes to home health care within the rule that providers should be paying attention to. 
CMS estimated that Medicare payments to agencies in 2025 would increase by 0.5%, or $85 million, compared to 2024. In addition to the slight payment increase, the rule introduced other changes for HHAs that may impact their business practices.

“This is not where we want to be,” William A. Dombi, president emeritus of the National Alliance for Care at Home, said during a recent webinar. “We are on a slippery slope toward potential disaster. We projected this would happen when we examined CMS’ methodology for budget neutrality. All CMS has done is mitigate the situation, rather than create a foundation for restoring the home health benefit to its intended state.”

Elara Caring CEO Scott Powers echoed this sentiment and urged CMS to reevaluate its payment model. 

“While CMS’ 2025 payment adjustments attempt to address some challenges faced by home health providers, the current approach remains inadequate,” Powers told Home Health Care News. “The budget neutrality methodology continues to undermine the fundamental purpose of home health care, limiting access for the seniors who rely on these services the most. We urge CMS to prioritize a payment model that genuinely reflects the value of home health care.”

With a presence in 18 states, Elara Caring provides an array of home-based care services across more than 200 locations, serving more than 60,000 patients. 

“CMS’ decision to implement a -1.975% permanent projected adjustment to home health payments is deeply concerning,” Compassus CEO Mike Asselta told HHCN. “This is particularly troubling as the demand for these services continues to rise. Concurrently, new conditions of participation increase the administrative burdens on home health agencies without adequately addressing critical issues like access to care.”

Based in Brentwood, Tennessee, Compassus also offers a wide range of home-based care services including home health care, home infusion, palliative care, hospice care and home-based high-acuity care, with more than 270 locations across 30 states.

Bud Langham, the executive vice president of clinical excellence and strategy for Enhabit Inc. (NYSE: EHAB) , expressed significant concern about the 2025 home health final rule. 
“The most pressing issue is yet another cut to home health reimbursement,” he said. “This marks the third consecutive implementation of negative permanent adjustments, along with planned temporary adjustments that are still pending. Congress needs to take action; over 60 million Medicare-eligible Americans are counting on it.”

In addition to the disappointing annual payment update, CMS has finalized several other changes that will affect home health providers starting in 2025 and beyond…

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