While hospice use continues to grow, there is still more work to be done in providing education and access to care. A study by the National Hospice and Palliative Care Organization (NHPCO) showed that only 44.6% of the deaths in the U.S. in 2011 were for patients enrolled in hospice.
Barriers to Hospice Care
We identified four key areas that can prevent or delay a patient’s referral to hospice:
- Education about Hospice. Patients, families and even health professionals are unclear about hospice benefits. They are especially unsure of what does and doesn’t make a patient eligible for hospice care. For example, many believe hospice to be a benefit for only the last days or last few weeks of life – instead of a six-month benefit under Medicare.
- Communication. Starting the conversation about hospice can be difficult, even for health care professionals. If a physician has had a long-term relationship with the patient, he or she may struggle to bring up the topic of end-of-life. Physicians also worry that initiating “the conversation” may cause a patient to lose hope. Since primary care physicians are often the gatekeepers to hospice referrals, these can present significant hurdles to hospice care.
- Hospice Enrollment Policies. A January 2013 article in Health Affairs shined a light on another barrier to hospice. What the study found was that hospice providers often have at least one enrollment policy that restricts access to care. It might be that a patient is utilizing chemotherapy, not in a curative fashion, but as a method of shrinking a tumor and managing pain. Another patient may still be receiving blood transfusions. Because hospice daily rates are often not enough to cover these types of treatments, the provider may not be able to admit the patient.
- Cultural Barriers to Hospice Care. There are definite cultural and ethnic barriers to care. Causes range from language barriers to spiritual beliefs and a mistrust of the health care system. African Americans make up only about 8% of hospice enrollment despite comprising 12% of the U.S. population and having high rates of death from the top two hospice diagnoses: heart disease and cancer. Chinese-Americans and Latinos also utilize hospice at lower rates. NHPCO developed hospice outreach guides for each of these three ethnic groups. These guides are free to download.
We hope you will join us again in April when we dig deeper in to the barriers to hospice. Our two-part Hospice Myth Busters series will explore some of the more popular myths about hospice.