In The News

Long COVID Has Caused Thousands of US Deaths: New CDC Data

Medscape | By Lisa Rapaport

While COVID has now claimed more than 1 million lives in the United States alone, these aren't the only fatalities caused at least in part by the virus. A small but growing number of Americans are surviving acute infections only to succumb months later to the lingering health problems caused by long COVID.

Much of the attention on long COVID has centered on the sometimes debilitating symptoms that strike people with the condition, with no formal diagnostic tests or standard treatments available, and the effect it has on quality of life. But new figures from the US Centers for Disease Control and Prevention (CDC) show that long COVID can also be deadly.

More than 5000 Americans have died from long COVID since the start of the pandemic, according to new estimates from the CDC.

This total, based on death certificate data collected by the CDC, includes a preliminary tally of 1491 long COVID deaths in 2023 in addition to 3544 fatalities previously reported from January 2020 through June 2022.

Guidance issued in 2023 on how to formally report long COVID as a cause of death on death certificates should help get a more accurate count of these fatalities going forward, said Robert Anderson, PhD, chief mortality statistician for the CDC.

"We hope that the guidance will help cause of death certifiers be more aware of the impact of long COVID and more likely to report long COVID as a cause of death when appropriate," Anderson said. "That said, we do not expect that this guidance will have a dramatic impact on the trend."

There's no standard definition or diagnostic test for long COVID. It's typically diagnosed when people have symptoms at least 3 months after an acute infection that weren't present before they got sick. As of the end of last year, about 7% of American adults had experienced long COVID at some point, the CDC estimated in September 2023.

The new death tally indicates long COVID remains a significant public health threat and is likely to grow in the years ahead, even though the pandemic may no longer be considered a global health crisis, experts said…

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FAQ About the CY 2024 Home Health Final Rule

WellSky

As 2024 has started, there is a lot to prepare for in the year ahead. Home health industry regulatory expert and advocate, Cindy Campbell, MHA-Healthcare Informatics, BSN, RN, COQS, CCS-HH, recently presented an important webinar that provided in-depth coverage of the final rule and how it will affect your home health agency’s future. This webinar is now available to watch on-demand. 

In this new FAQ tip sheet, Cindy provides answers to the most frequently asked questions about the CY 2024 Home Health Final Rule.

Download Now

 

Why Do You Want to Support People Who are Dying? 

Barbara Karnes, RN

I was recently asked how to be a Hospice volunteer. My answer was to call any hospice and ask how to be part of their volunteer program.

However the real question is “Why do you want to be a hospice volunteer? Why do you want to support people who are dying?”

Being involved with end of life care is not something most people want to do, so what brings you? Is it because you have had a hospice experience and want to give back? I have witnessed many people whose special person I cared for during the end of their life become hospice volunteers. 

HOWEVER, I suggest a person wait a year. The grief wound is too fresh to work in end of life before then. Come to the ongoing bereavement support group and then if you are still interested, we would love to have you. Particularly since you have walked in the shoes you will be supporting.

Another self searching question I ask potential volunteers is what is your belief regarding death? Before we can help others we have to understand ourselves, our motivations, our belief systems. I will add here that if an interest is to share your belief with others, then this is not the place for you. Hospice philosophy accepts and supports all religions and nonreligious beliefs. 

I think another area to explore before becoming a hospice volunteer are your own personal experiences with dying and death. Explore the emotions and yes, fears surrounding the end of life.

Hospice’s role in volunteer training is providing education about end of life and ongoing support. Working with end of life situations is rewarding and fulfilling and it is an area not many feel called to enter. All the more reason to understand the “why” of being there.

 

What Causes One of Stroke's Most Common Complications?

Medscape | Batya Swift Yasgur, MA, LSW

The mechanisms underlying poststroke depression (PSD), a common and debilitating complication of stroke, are unclear. Is it neurobiological, psychosocial, or both?

Two studies offer new insight into this question. In the first, investigators systematically reviewed studies comparing stroke and non-stroke participants with depression and found the groups were similar in most dimensions of depressive symptoms. But surprisingly, anhedonia was less severe in patients with PSD compared with non-stroke controls, and those with PSD also showed greater emotional dysregulation.

"Our findings support previous recommendations that clinicians should adapt the provision of psychological support to the specific needs and difficulties of stroke survivors," lead author Joshua Blake, DClinPsy, lecturer in clinical psychology, University of East Anglia, Norwich, United Kingdom, told Medscape Medical News.

The study was published online on September 5, 2023, in Neuropsychology Review.

A second study used a machine learning algorithm to analyze blood samples from adults who had suffered a stroke, determining whether plasma protein data could predict mood and identifying potential proteins associated with mood in these patients.

"We can now look at a stroke survivor's blood and predict their mood," senior author Marion Buckwalter, MD, PhD, professor of neurology and neurosurgery at Stanford Medicine, California, said in a news release. "This means there is a genuine association between what's happening in the blood and what's happening with a person's mood. It also means that, down the road, we may be able to develop new treatments for PSD."

The study was published in November 2023 in Brain, Behavior, and Immunity.

'Surprising' Findings

"There has long been uncertainty over whether PSD might differ in its causes, phenomenology, and treatability, due to the presence of brain injury, related biological changes, and the psychosocial context unique to this population," Blake said. "We felt that understanding symptomatologic similarities and differences would constructively contribute to this debate."

The researchers reviewed 12 papers that sampled both stroke and non-stroke participants. "We compared profiles of depression symptoms, correlation strengths of individual depression symptoms with general depression, and latent item severity," Blake reported.

They extracted 38 symptoms from five standardized depression tools and then organized the symptoms into nine dimensions.

They found mostly nonsignificant differences between patients with PSD and non-stroke controls in most dimensions, including negative affect, negative cognitions, somatic features, anxiety/worry, and suicidal ideation. Those with PSD more frequently had cognitive impairment, and "work inhibition" was more common in PSD.

But the most striking finding was greater severity/prevalence of emotional dysregulation in PSD vs non-stroke depression and also less anhedonia…

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Draft OASIS-E1 Instrument Now Available

NAHC Report

The Centers for Medicare & Medicaid Services (CMS) recently posted the draft OASIS-E1 All Items instrument, scheduled for an effective date of January 1, 2025. The accompanying OASIS-E1 Manual will be released at a later date. An Office of Management and Budget (OMB) number and the information collection timeframe estimate are yet to be assigned. 

The OASIS document needs to be updated to accommodate some changes related to policy including the end of the temporary suspension of OASIS for non-Medicare/non-Medicaid home health patients and the removal and addition of OASIS items related to measures for the Home Health Quality Reporting Program (HHQRP), payment calculation, and/or Medicare conditions of participation.

Beginning in 2025, home health agencies will need to collect OASIS data for all patients regardless of payor source. Existing exemptions will continue for those under the age of 18, receiving maternity services, or those receiving only personal care, housekeeping or chore services.  A phase-in period is in place for January 1, 2025 through June 30, 2025 in which failure to submit the data will not result in a penalty.  Mandatory collection and reporting begin with discharges on or after July 1, 2025.

CMS is adding the COVID-19 Vaccine measure to the HH QRP necessitating the addition of data collection through the OASIS and also removing OASIS items that are no longer necessary:

  • M0110 – Episode Timing
  • M2220 – Therapy Needs
  • GG0130 and GG0170 – Discharge Goal

NAHC staff are reviewing the document and will provide more information after an analysis of the to be released OASIS-E1 Manual.

 
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