Podcast: Improving CAHPS Scores

Episode 118: Jon R sits down with NHPCO's Jennifer Kennedy and special guest Natalie McNeal, Executive Director of WellStar Community Hospice in Georgia. Jennifer provides an update on the latest news from CMS related to the CAHPS survey, and Natalie shares how her hospice adapted their practices in a COVID world to maintain their scores. Hear some practical tips of how your hospice can address low scoring topics in innovative ways. Listen now.

Hospice Action Network - Expanding Access to Palliative Care Act (S.2565)

Palliative care is patient and family-centered support that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information and choice. 

Right now, Medicare beneficiaries are in need, because they cannot access home-based palliative care. This means that patients and families miss out on the wealth of resources and support that palliative care providers can offer.  

To address these needs, the National Hospice and Palliative Care Organization and the Hospice Action Network have been leading efforts to expand access to palliative care across the country.  

We support the Expanding Access to Palliative Care Act (S. 2565), which would direct the Innovation Center at the Center for Medicare and Medicaid Innovation (CMMI) to implement a Community-Based Palliative Care Demonstration.  

Access to palliative care where a patient calls home will improve patients' quality of life, allowing patients and families to spend more time together, and less time in doctors' offices and emergency rooms. It will also protect medically vulnerable people from unnecessary exposure to COVID-19 and other illnesses.  

Click Here to call on your Senators to support the Expanding Access to palliative Care Act!

Moderna COVID-19 Vaccine Generates Long-Lasting Immune Memory

National Institutes of Health (NIH)

The Moderna and Pfizer mRNA vaccines against COVID-19 have shown greater than 90% effectiveness soon after the second dose. Studies suggest that protective immunity remains high, with only slight decreases, over six months. However, scientists are still working to understand how immunity against the virus develops after vaccination and changes over time.

Researchers believe that strong responses from both neutralizing antibodies and immune cells called T cells are necessary for immunity. Memory T cells linger in the body to recognize and protect against previously encountered pathogens. Recent studies indicate these may be crucial for lasting protection against COVID-19. 

A research team led by Drs. Daniela Weiskopf, Shane Crotty, and Alessandro Sette of the La Jolla Institute for Immunology looked at immune memory six months after vaccination. They were also interested in how immune memory from previous exposure to coronaviruses, which can cause common colds, might affect the vaccine-induced immune response.

The work was primarily funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID). Results appeared in Science on September 14, 2021.

The study examined 35 participants enrolled in a phase 1 clinical trial of the Moderna vaccine. They had received two 25-microgram injections—a quarter of the standard dose authorized for emergency use by the FDA.

The team assessed antibody and T cell levels after the first and second doses, and again six months later. They measured two subsets of T cells: CD8+ T cells, or “killer” T cells, which destroy virus-infected cells, and CD4+ T cells, “helper” T cells involved in antibody production.

Levels of antibodies, CD4+ T cells, and CD8+ T cells remained strong six months after receiving the vaccine. This was found even among participants over 70 years of age, who are particularly vulnerable to severe COVID-19. Memory CD4+ T cells were still present in nearly everyone six months after full vaccination. Memory CD8+ T cells were detected in 67% of participants six months after full vaccination. Until this study, it was uncertain whether the Moderna vaccine elicited these memory T cells. 

The team also found that the vaccine generated similar immune memory against the SARS-CoV-2 spike protein to that of natural infection. Levels of antibodies, CD4+ T cells, and CD8+ T cells six months after vaccination were comparable to those in recovered individuals.

In addition, the researchers found that “cross-reactive” T cells—those made during infection with other coronaviruses that can cause the common cold—enhanced the vaccine response. People with cross-reactive T cells before vaccination had significantly stronger CD4+ T cell and antibody responses.

Taken together, the study suggests that immune memory resulting from the Moderna vaccine, even at low doses, is long-lasting.

“The immune memory was stable, and that was impressive,” Crotty says. “That’s a good indicator of the durability of mRNA vaccines.”

—by Erin Bryant

Seasonal Affective Disorder (SAD)

National Center for Complimentary and Integrative Health (NIH)

As the days grow shorter in the fall, some people develop symptoms of seasonal affective disorder (SAD), a type of depression with a recurring seasonal pattern. 

Several types of treatment can be helpful for SAD symptoms. They include antidepressant medications, cognitive behavioral therapy, and light therapy—which involves daily exposure to bright artificial light every morning, from early fall until spring.

The evidence on dietary supplements for SAD is limited. Although low levels of vitamin D have been found in people with SAD, it’s unclear whether vitamin D supplementation can help relieve SAD symptoms. Very little research has been done on supplements other than vitamin D, so no conclusions can be reached about their effects.

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