HHS Delivers Strategic Framework for National Plan on Aging

U.S. Department of Health and Human Services

Today the U.S. Department of Health and Human Services, through its Administration for Community Living, released “Aging in the United States: A Strategic Framework for a National Plan on Aging.” The report lays the groundwork for a coordinated effort – across the private and public sectors and in partnership with older adults, family caregivers, the aging services network, and other stakeholders – to create a national set of recommendations for advancing healthy aging and age-friendly communities that value and truly include older adults. The national plan on aging will advance best practices for service delivery, support development and strengthening of partnerships within and across sectors, identify solutions for removing barriers to health and independence for older adults, and more. Developed by leaders and experts from 16 federal agencies and departments working together through the Interagency Coordinating Committee (ICC) on Healthy Aging and Age-Friendly Communities, the report also reflects input from community partners and leaders in the aging services network.

“Ensuring that every American can age with dignity has been a priority throughout the Biden-Harris Administration and is at the core of our work at HHS,” said HHS Secretary Xavier Becerra. “From day one, we have focused on lowering prescription drug costs, improving support for family caregivers, strengthening the workforce that provides in-home services, increasing access to health care and more to support older adults. The Strategic Framework provides a roadmap for us to build upon that progress to improve the experience of aging in our country.”

“The rapidly growing population of older adults creates an urgent need for thoughtful planning and coordinated action to strengthen the systems that support health and wellbeing as we age,” said Alison Barkoff, who leads the Administration for Community Living. “ACL was proud to lead the development of this strategic framework, and we are excited to work with our partners at every level of government, across sectors, and with older adults to develop a national plan on aging.”

The Strategic Framework captures the opportunities and challenges created by the aging of the U.S. population and defines goals and objectives for addressing critical aging issues. It considers the many factors that influence the aging experience, as well as things all people need as they age, such as coordinated housing and services, aligned health care and supportive services, accessible communities, age-friendly workplaces, and high-quality long-term services and supports. Within these, the framework discusses key issues and work underway across the federal government, such as availability of affordable and accessible housing and promoting economic and financial security.

On June 10 at 2 p.m., ACL will host a public webinar to provide an overview of the Strategic Framework (advance registration is required.) In the coming months, the ICC will engage with stakeholders across the nation to explore the opportunities and issues in the Strategic Framework and inform the development of the national plan on aging…

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How Fraudulent Hospices Evade Regulators

Hospice News | By Jim Parker

A slew of fraudulent hospices in California are dodging consequences by shuffling patients around between provider numbers.
 
That’s according to multiple sources who spoke with Hospice News, expressing their concerns about patterns of fraud continuing even as government regulators crack down on the sector.
 
Since 2021, numerous media and government reports have emerged of unethical or illegal practices among hundreds of newly licensed hospices, particularly among new companies popping up in California, Texas, Nevada and Arizona. Despite the best efforts of regulators and law enforcement, hospice leaders are concerned that many bad actors are slipping through the cracks.
 
“As more regulation comes in, it really doesn’t matter. You can give me a regulation right now and in three seconds, I can give you a way to work around it,” a hospice owner told Hospice News on condition of anonymity. “Because I know my industry, I can find a work-around for any regulation … Our systems are filled with loopholes.”
 
Industry associations also are aware of this issue, according to Logan Hoover, vice president of health policy and government relations at the National Hospice and Palliative Care Organization (NHPCO).
 
“It is deeply concerning that we continue to see sophisticated fraud attempts in multiple states, targeting beneficiaries and defrauding taxpayers. These deceitful actions reveal that serious vulnerabilities still exist in our system,” Hoover told Hospice News in an email.
 
One principal tactic among these hospices is maintaining multiple provider numbers, hospice leaders told Hospice News on background. This enables perpetrators of fraud to move patients between the various hospices they own. Another common practice is transferring patients who have reached the payment cap to avoid recoupment.
 
“I always get agencies that ask me to swap patients with them,” a hospice CEO said. “They say, ‘Maybe we can swap some patients out this way and you can eat into your cap, because my patients don’t have cap space.’”…

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It’s Okay Not to Eat! Food at End of Life

By Barbara Karnes

FOOD! We eat to live. It sustains living. Everyone and everything needs some form of food, of nourishment, to maintain life. Animals (and that includes humans), plants, insects, all need some form of food to live. It seems that with humans, we add to the nourishment aspect of eating a social component as well as an emotional one. We socialize with food. We show love with food.

My husband Jack has been dead eight months. In processing the five months from his diagnosis to his death, what stands out most for me is the tension that surrounded food. AND I KNEW BETTER!

As his body was declining, I experienced a driving intensity to feed him. He ate less and less, while I pleaded, badgered, coaxed, and pushed food on him. His not eating “enough” became our biggest point of tension. I never said, “You are dying and you need to eat,” but I was thinking it.

One day after a particularly tense session of his not eating and my strongly encouraging him to eat, I left the room in tears. It was then that I saw the obvious: I was trying to keep him alive while his body was preparing to die. Even with all my knowledge of end of life, my husband was going to die and my feeding him wasn’t going to change the outcome. It was only making this precious time together more challenging and disruptive.

I‘ve thought about my reactions. If I felt this frustration and even panic with all the knowledge and experience that I have, how do others, without the knowledge, cope? Probably poorly. SO I wrote a booklet, Always Offer, Never Force. This short booklet is in the format of my others. It addresses eating and not eating as end of life approaches, with some nutritional guidelines as well as what foods to offer. 

Just as there are new rules in pain management, in sleep, in socialization at end of life, there are new rules for eating. My hope is that by reading about the normal progression of eating to not eating and what to do to help our special person during that time, my booklet can guide and support others as they journey this challenging road toward life’s conclusion.

How do I see Always Offer, Never Force being used?

• Always Offer, Never Force is a companion to Gone From My Sight and The Eleventh Hour.
• Include it with the initial hand out materials.
• Read it with families and caregivers as a teaching tool. 
• Brand it with your agency name and logo.
• It is not just for Hospice use, but for Palliative Care programs and End of Life Doulas, as well.

How Do You Train Your Hospice Volunteers?

By Barbara Karnes

I was thinking about hospice volunteer training. What makes a good training program? I am hearing stories about the lack of professional staff training for new hires, which led me to wonder about volunteer training. 

So - here are my thoughts for a hospice volunteer training program:

1. At the first meeting of the training, have a discussion focusing on why the person wants to be a volunteer in the end of life arena. It is not an area most people are interested in, so why are they?
2. When was their last experience with death? Often there can still be unresolved grief issues. I suggest that at least one year has passed since the death of a significant person in the potential volunteer’s life. Working with end of life patients may trigger their own memories and interfere with objectivity in giving help. (Note that steps 1 and 2 should come before the following steps. We need to see why they are drawn to this area before anything else. These steps may be the time that the prospective volunteer decides hospice volunteering is not the work for them. It is also the point at which the hospice coordinator decides it is not a good fit for the applicant.)
3. Now explain the role of a volunteer. Go over what is expected and what is not acceptable. 
4. Begin teaching the signs of approaching death. Go over what the signs will look like in the months, weeks, and hours before death. Particularly address how eating, sleep, socialization will change. Provide lecture-style teaching, take-home reading materials, and written assignments.
5. Teach the basics of nutrition, skin care, pain management, and monitoring activity levels. Not because the volunteer will be doing care, but because they are the eyes of the professional staff and can report their observations.
6. Teach effective and sensitive communication and active listening skills.
7. Go over the specifics of dementia at end of life and how to interact with someone with the disease.
8. The basics of grief are another important component of end of life training. Again, lecture and provide reading materials and written assignments.
9. Offer guidance on self-care. Offer guidance on the importance of entering the patient/caregivers life as a support person, and how we don’t become personally involved. Lecture on creating a closure ritual, having a buddy system, and when and how to contact a bereavement coordinator for personal support should the need arise.

I suggest The Final Act of Living, By Your Side and the End of Life Guideline Series Bundle be required reading. These will provide a strong baseline in end of life knowledge. I also recommend these for medical professionals working in the end of life area.