Capital Caring Health has created a new Center of Equity, Inclusion and Diversity to improve access to care for members of demographics that have been historically underserved by hospice and the health care system at large, including the African American, Hispanic, Asian, Jewish and LBGTQ+ communities.
Virginia-based Capital Caring serves patients with serious and chronic illness in its home state as well as Maryland and the District of Columbia, including hospice, palliative care, home-based primary care and other services.
While the organization has done outreach to underserved populations for many years, its leaders were inspired to launch the center by recent events surrounding the resurgence of the Black Lives Matter movement and the surrounding public discourse.
“We have been working on these issues and really have been committed to inclusion and diversity and equity since the beginning of the organization. We’ve really made this a focus,” Capital Caring Health CEO Tom Koutsoumpas told Hospice News. “The actual idea of the center was a progression that was inspired by recent events.”
More than 82% of Medicare decedents who elected hospice in 2017 were caucasian, according to the National Hospice & Palliative Care Organization (NHPCO). Comparatively, slightly more than 8% were African-American; 6.4% were Hispanic, and 1.7% were Asian. That year, only 0.4% of Medicare decedents were Native American.
In addition to lower rates of overall utilization, hospice patients who are members of minority communities are more likely to leave hospice, be admitted to the hospital, or visit the emergency department, research has found.
Data are scarce regarding hospice utilization among the LBGTQ+ community, but available research indicates that those groups are also underserved. A 2018 AARP study found that 60% of the LGBTQ+ community are concerned about a lack of sensitivity to their needs among health care providers.
Capital Caring has a longstanding committee devoted to outreach to underserved communities but felt it was time to take these efforts to another level, including reaching disparate religious groups.
“Early this year we finished up accreditation for the National Institute for Jewish Hospice Services. So all of our programs are trained in the care and traditions and values of serving Jewish hospice patients, and we became a stigma-free company with the [National Alliance On Mental Illness],” Altonia Garrett, vice president of public affairs and strategic partnerships said. “We also had our non-discrimination statement updated to reflect that we care for everyone, to put it out there that we go the extra mile, prior to the development of the center.”
Garrett will lead the center as its executive director, with Keith Everett, chief officer of performance, cultural operations, and compliance.
A number of factors impact the reluctance of members of underserved communities to elect hospice or seek other forms of health care. Part of the issue is a lack of awareness or understanding of hospice among the general public, but mistrust stemming from past negligence or mistreatment in health care also undermines efforts to reach underserved groups.
Many African-Americans, for example, remember the Tuskegee incident, in which researchers conducted experiments on black syphilis patients, often without informing the patients that they had the disease. The experiment went on for 40 years between 1932 and 1972.
Capital Caring’s center will not only be focused on increasing diversity among its patients, but also among its workforce.
“The center is going to be focused on three fundamental practices. One is to develop integrative approaches and programs to reach the diverse populations we serve,” said Everett. “We are also looking into creating programs for those communities and the black and brown communities as well. We look to attract and retain a talented diverse workforce. We are looking at all aspects of that, and then developing external programs to address equality for those patient populations that we have not been able to penetrate. We have to get comfortable being uncomfortable — having a lot of difficult conversations, going out into the communities and having these conversations to understand what these diverse populations need from us.”