A Review of Barriers to Utilization of the Medicare Hospice Benefits in Urban Populations and Strategies for Enhanced Access
Disparities in access to health care extend to end-of-life care. Lack of access to hospice mirrors lack of access to health maintenance and primary care. Patients who are served by hospice nationally are disproportionately white and likely to reside in economically stable communities. In many urban low-income communities, less than 5% of decedents receive hospice care in the last 6 months of life. This review focuses on barriers to palliative care and hospice in urban, predominantly low-income communities, including cultural and reimbursement factors and the paucity of hospice providers, outreach projects, and in-patient hospice beds in urban communities. This review will also address some strategies that are being implemented by hospices locally and nationally to overcome demographic barriers to hospice care.
KeywordsEnd-of-life Health disparities Hospice Urban
- 1.Jennings B, Ryndes T, D’Onofrio C, Baily M. Hastings Center Report, Special Supplement, Access to Hospice Care: Expanding Boundaries, Overcoming Barriers, March/April 2003.Google Scholar
- 2.The Last Acts Coalition, Means to a Better End: A Report on Dying in America Today. Washington DC: Partnership for Caring. November 2002. Available at: www.lastacts.org. Accessed on 12/24/04.
- 3.Hastings Center Report, Special Supplement, Access to Hospice Care: Expanding Boundaries, March/ April 2003; pS3–S4.Google Scholar
- 6.Hospice and Palliative Nurses Association. Core Curriculum for the Generalist and Palliative Care Nurse. Iowa: Kendall/Hunt; 2002.Google Scholar
- 7.National Hospice and Palliative Organization. Facts and Figures. 2003. Available at www.nhpco.org. Accessed on 12-1-06
- 8.Medicare and End-of-life care. Last Acts Financing Committee, Washington, DC 2002.Google Scholar
- 10.Hogan C, Lynn J, Gabel J, Lunney J, O’Mara A, Wilkinson A. Medicare Beneficiaries Cost and Use of Care in the Last Year of Life. Washington, DC: MedPAC; 2006; publication No.00-1.Google Scholar
- 13.O’Mahony S. Cancer Pain: prevalence and under treatment. In: Portenoy R, ed. Cancer Pain; assessment and management. New York, NY, USA: Cambridge Press; 2003:38–51.Google Scholar
- 14.Stjernsward CD. Palliative Medicine—a global perspective. In: Doyle D, Hanks G, Cherny N, Calman K, eds. The Oxford Textbook of Palliative Medicine. Oxford England; 2005:1197–1225Google Scholar
- 25.Barrett RK, Hall A, Neuhaus C. U.S. minority health: a chart book. New York: The Commonwealth Fund; 1999.Google Scholar
- 26.Barrett, RK, Heller KS. Death and dying in the black experience: an interview with Barrett RK. Innovations in End-of-Life Care. 2001; 3: 5. Available at www.edc.org/lastacts viewed on 6.7.07.
- 28.The Dartmouth Atlas of Health Care. Available at www.dartmouthatlas.org. Accessed on 6.1.06.
- 31.O’Mahony S, Blank A, Simpson J, et al. Preliminary Report of a Palliative Care and Case Management Project in an Emergency Department for Chronically Ill Elderly Patients. J Urban Health. 2008; In Press.Google Scholar