Journal of Urban Health

, Volume 85, Issue 2, pp 281–290

A Review of Barriers to Utilization of the Medicare Hospice Benefits in Urban Populations and Strategies for Enhanced Access

  • Sean O’Mahony
  • Janet McHenry
  • Daniel Snow
  • Carolyn Cassin
  • Donald Schumacher
  • Peter A. Selwyn


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.


End-of-life Health disparities Hospice Urban 


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Copyright information

© The New York Academy of Medicine 2008

Authors and Affiliations

  • Sean O’Mahony
    • 1
    • 2
  • Janet McHenry
    • 1
  • Daniel Snow
    • 1
  • Carolyn Cassin
    • 3
  • Donald Schumacher
    • 4
  • Peter A. Selwyn
    • 1
    • 2
  1. 1.Palliative Care Service, Department of Family and Social MedicineMontefiore Medical CenterBronx, New YorkUSA
  2. 2.Albert Einstein College of MedicineBronx, New YorkUSA
  3. 3.Continuum Jacob Perlow HospiceNew YorkUSA
  4. 4.National Hospice and Palliative Care OrganizationAlexandriaUSA

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