Providers Strategize to Close Racial Gaps in Hospice Care

While several health care providers have expanded their diversity initiatives to bridge racial divides, hospices have much room to grow in fostering stronger connections with underserved communities of color. Hospice providers who participated in a recent nationwide study indicated that increasing staff diversity and developing committees dedicated to diversity initiatives were strategies yielding the most beneficial outcomes thus far.

Race and socioeconomics represent the largest barriers to hospice and palliative care. More than 80% of Medicare hospice patients in 2018 were Caucasian, according to the National Hospice and Palliative Organization (NHPCO), while African American, Asian, Hispanic and Hispanic patients made up less than 20% of the remaining beneficiaries that year.

While health care disparities affecting people of color have been pervasive for decades, last year’s nationwide civil unrest has brought racial equity to the forefront of hospice providers’ minds. A majority of the hospice providers who participated in a 2020 study published in the BMJ Supportive & Palliative Care Journal indicated that racial, ethnic and minority disparities were an impetus for establishing greater diversity initiatives within their organizations.


“We learned that there is a strong desire among hospices to do more for inclusion,” said one of the study’s researchers, M. Courtney Hughes, associate professor of public health at Northern Illinois University. “While implementing some of these interventions takes effort, now is an ideal time to do more. Community needs extend beyond end-of-life care. Hospices engaging in outreach to help address other pressing social issues can build trust and goodwill within the community.”

Hospice-targeted programs and policies that facilitate language translation, diversity among staff, enhanced community outreach, and company-wide collaboration regarding inclusion were found to be avenues of success for racial and minority inclusion, according to providers who participated in the study.

A growing number of hospices have launched or invested more resources into diversity initiatives, with many indicating that this would be a top priority in 2021, according to an Axxess report earlier this year.


“The greatest challenge to implementing some of these [diversity] interventions, is making sure that the goals are aligned — it’s really about alignment all across the board with every team,” said Nicole McCann-Davis, director of communications and multicultural affairs for Illinois-based Seasons Hospice & Palliative Care. “Once you get past that and you’re able to align everyone with the same goal, then you can focus on the next layer, which is how to start building relationships with community leaders who may not necessarily be in the medical field.”

Seasons was among the hospice providers who participated in the nationwide study that examined strategic approaches of hospices working to improve racial and ethnic hospice utilization disparities. Part of the relationship building involves consistency, according to McCann-Davis, who also serves as chair of NHPCO’s Diversity Council.

“In terms of the long-term success of different hospice organizations, it’s imperative and critical that we are building those long-term relationships so that you’re looked to as a community partner, and not just a health care provider,” McDann-Davis told Hospice News. “We need to reach out and start to build relationships, because if you do it only one time, then that’s not going to truly help to break down barriers and build trust within your community.”

The study’s findings suggested that forming a committee focused on diversity initiatives is among the best practices for hospices beginning to employ inclusion strategies. All but one of the 22 hospice leaders surveyed reported successful inclusionary approaches stemming from the formation of a focused diversity committee, with one-third reporting that they had established a committee within the three months prior to the June and July 2020 survey, or planned to do so in the near future. Of those, another third reported that the committee’s benefits outweighed the associated costs.

Costs can vary significantly depending on various factors such as a hospice organization’s size, service area and level of integration, according to another researcher for the study, Erin Vernon, assistant professor of health economics at Seattle University.

“One pattern we found in our research in this regard was that hospice leaders consistently mentioned that the higher hiring and salary costs that arise from hiring a more diverse and bilingual staff more than paid for itself within a two year period via increased inclusivity and patient satisfaction rates,” Vernon told Hospice News.

Responding organizations ranged in size and were predominantly non-profit hospices spread out across different regions in the United States. A majority held leadership or executive level titles. Forming a committee can be a low-cost step for hospices to take when kickstarting their inclusion efforts, according to Hughes.

In addition to weighing the costs involved, hospice providers will need systematic changes in their staff hiring and training processes. More diverse representation among health care workers could bridge understanding around the disparities plaguing hospice and palliative care, as well as support the business case for greater inclusion practices.

“The most important factor is that quality at the end of life has been shown to increase when individuals enter hospice care, but overall health care costs decrease as well when this happens,” said Vernon. “Taking steps to reduce this health disparity not only improves quality of care for under-represented individuals, but also contributes to reducing our unsustainable health care costs.”

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