Across the past few years, our society has become increasingly aware of the social, economic, and environmental factors that impact people’s health. The CDC identifies housing security, income, education, social connections, and neighborhood conditions as key drivers in shaping seniors’ health trajectories. I think that anyone within the healthcare and/or social services field would agree with this wholeheartedly.
While Americans’ health trajectories are inevitable at the time they become eligible for hospice services, SDOH (Social Determinants of Health) still play a major role for the patients and families our field is privileged to serve.
We know that quality hospice care can serve as an intervention to support all patients, especially those who are restricted by various SDOH factors, including limited access to nutrition, medical oversight and interventions, and literacy, among others.
But, to fully impact health equity, we also must be cognizant of other examples of SDOH, such as racism and implicit bias. Unfortunately, our collective field has not been as successful in addressing access to hospice care across differing racial and ethnic groups. According to HealthPivots, disparities in access to hospice care remain among racial groups. California is the most racially diverse state, followed by Texas and then Florida, and each of these states has significant discrepancies in utilization between White and Black and Brown communities, and these differences are reflective of our nation as well.
|
Group |
California |
Texas |
Florida |
|
All Medicare Beneficiaries’ Death Service Ratio |
45% |
56% |
59% |
|
Black DSR |
32% |
43% |
45% |
|
Hispanic DSR |
31% |
43% |
45% |
|
Asian DSR |
34% |
42% |
46% |
|
Native/Indian DSR |
38% |
53% |
49% |
|
White DSR |
50% |
59% |
61% |
Death Service Ratio (DSR) is the percentage of Medicare Beneficiaries who died with the benefit of hospice services.
Certainly, there are some pockets of improved access. One Teleios member organization, Ancora Compassionate Care, recognized the alarming disparities within its community and set about to create change. Ancora leaders recognized that the Black community in their service area typically placed high trust in their religious leaders. To better understand their needs and preferences regarding end-of-life care and services, Ancora embarked on a "listening tour" to gather feedback and insights from these religious leaders. Using the wisdom imparted, Ancora adapted their care delivery to be more inclusive to the Black community. As such, the organization is making incremental improvements in lessening the racial divide in access to hospice care.
While hospice organizations consider growth strategies to move forward in increasing access to care, SDOH must be considered to fulfill Dame Cicely Saunders’ vision: “You matter because you are you, and you matter to the end of your life. We will do all we can, not only to help you die peacefully, but also to live until you die.”
Alyson Cutshall, Chief Growth Officer
*Data retrieved from Hospice Analytics (www.nationalhospiceanalytics.com).
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