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The article evaluates medical therapies in the nursing home (NH) population in 2024. Topics covered include concerns on the issues of inadequately trained and insufficient staff, high staff turnover, and lack of accountability and transparency, the need for clinical trials in NHs and their possible filling of gaps therein, the challenges in conducting trials, and addressing them through interventions and trial design. Also noted is a framework for realizing a NH clinical trials network.

Purpose: To compile the literature on the effects of rural hospital closures on the community and summarize the evidence, specifically the health and economic impacts, and identify gaps for future research. Methods: A systematic review of the relevant peer‐reviewed literature, published from January 2005 through December 2021, included in the EMBASE, CINAHL, PubMed, EconLit, and Business Source Complete databases, as well as "gray" literature published during the same time period. A total of 21 articles were identified for inclusion. Findings: Over 90% of the included studies were published in the last 8 years, with nearly three‐fourths published in the last 4 years. The most common outcomes studied were economic outcomes and employment (76%), emergent, and non‐emergent transportation, which includes transport miles and travel time (42.8%), access to and supply of health care providers (38%), and quality of patient outcomes (19%). Eighty‐nine percent of the studies that examined economic impacts found unfavorable results, including decreased income, population, and community economic growth, and increased poverty. Between 11 and 15.7 additional minutes were required to transport patients to the nearest emergency facility after closures. A lack of consistency in measures and definition of rurality challenges comparability across studies. Conclusions: The comprehensive impact of rural hospital closures on communities has not been well studied. Research shows predominantly negative economic outcomes as well as increased time and distance required to access health care services. Additional research and consistency in the outcome measures and definition of rurality is needed to characterize the downstream impact of rural hospital closures. [ABSTRACT FROM AUTHOR]

Despite evidence that specialized care for seriously ill nursing home (NH) residents is needed, barriers to accessing palliative care (PC) remain. A significant issue is the complexity of the referral process that inhibits timely and equitable access to care. This qualitative descriptive study explored the PC referral process in NHs. Using rapid qualitative analysis with semi-structured interview data from NH staff, primary care, and specialty PC providers ( N = 17) in six states, this study outlines a multistep referral process along with barriers and proposed solutions. Key recommendations include comprehensive PC education program development, implementation of an evidence-based PC screening tool, and the holistic integration of PC services in NHs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Connie S. Cole: no conflicts of interest. C. Robert Bennett: no conflicts of interest. Joan G. Carpenter: no conflicts of interest. Regina M. Fink: no conflicts of interest. Amy Jackson: no conflicts of interest. Kathleen T. Unroe: Dr Unroe is the founder of Probari, Inc, a healthcare startup supporting high quality NH care. Cari R. Levy: no conflicts of interest.

Objectives: Advance care planning (ACP) is considered a best practice in the nursing home setting; however, there is a lack of consistency in the training of nursing home staff and implementation of structured ACP programs. A qualitative study interviewing ACP specialists in nursing homes was conducted to understand the experience of staff engaged in Aligning Patient Preferences - a Role offering Alzheimer's patients, Caregivers, and Healthcare providers Education and Support (APPROACHES), an embedded pragmatic clinical trial to improve ACP., Design: Qualitative interviews regarding ACP specialists' experiences and perceived intervention impact., Setting and Participants: Staff of intervention-assigned nursing home facilities who completed a minimum of 10 ACP conversations with residents during APPROACHES program implementation., Methods: Fourteen staff were interviewed. Interviews were transcribed and coded by the research team., Results: There were 21 codes identified that were then distilled into the following 5 themes: (1) experiences with the ACP specialist program, (2) engaging in ACP conversations, (3) considerations related to dementia, (4) benefits and challenges of ACP, and (5) involvement of multiple people in the ACP process. Participant responses suggested variability in experiences with the ACP specialist program and highlighted many aspects relevant to engaging in conversations with families and residents, particularly those living with dementia. Benefits of ACP, including relationship building and increased preparedness for changes in health status, were balanced with challenges related to sensitive conversation topics and logistical difficulties in scheduling ACP discussions. ACP specialists discussed the multiple roles that others played in the ACP process., Conclusions and Implications: Findings from this analysis provide insights into tailoring APPROACHES and other ACP programs for full-scale implementation in the nursing home setting. Nursing home staff experiences tailoring the program to fit their environments were reflective of the pragmatic nature of the ACP specialist program., Competing Interests: Disclosures K. T. U. is the founder of Probari, a health care start-up focused on clinical support of nursing home care., (Copyright © 2024 Post-Acute and Long-Term Care Medical Association. Published by Elsevier Inc. All rights reserved.)