Diversity Initiatives a Rising Priority for Hospices

Race continues to represent one of the largest barriers to hospice and palliative care. Hospice and palliative care providers are honing in on equity and inclusion, seeking to foster diversity among patients and staff alike.

The United States population has grown more racially and ethnically diverse as it ages, according to a U.S. Census Bureau report from June 2020. From 2010 to 2019, the national Asian population outpaced other groups with an increase of 29.3%, with the Hispanic population up by 20% and t`he Black or African American population growing by 11.6%. The White or Caucasian population saw an increase of 4.3% during that time frame.

Getting to the root of racial and socioeconomic barriers to hospice care will be key for hospices working to improve diversity. 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.


Yolo Hospice serves five counties across Northern California. The non-profit hospice provider works in concert with a coalition of other nonprofit hospice organizations to “raise the bar on end-of-life care” in their state together by focusing on what is most important to local communities, according to Craig Dresang, CEO of Yolo Hospice. The hospice recently launched a program to boost utilization among Native Americans.

“Native Americans are just not accessing this care at the same level that other populations are in our country,” Dresang told Hospice News. “We want to understand why that is, and how we can help overcome barriers. What we don’t know clearly is what’s keeping them from accessing hospice and receiving that kind of care and attention when they need it most.at the end of their lives.”

According to the Census Bureau, the Native American population grew by 13.1% from 2010 to 2019, with the largest concentration in Los Angeles County, Calif. Despite this growth Native Americans are among the most underserved groups by hospice and palliative care providers.


Native Americans made up a mere 0.4% of Medicare decedents electing hospice in 2018, according to NHPCO. This rate fell far behind other groups of color, with hospice utilization among African American populations at 8.2% and 6.7% among Hispanic that year.

Race, ethnicity and socioeconomic status are the leading differentiating factors fueling disparities in hospice utilization. Similar to Capital Caring Health and SCAN Health Plan, Yolo Hospice has intensified focus on programs intended to improve equitable access to end-of-life care among diverse populations.

Yolo Hospice recently received a $1 million grant from the Yocha Dehe Wintun Nation to fund research and efforts to counteract the challenges that residents of rural and Native American communities face regarding end-of-life care. This can include economic barriers and social determinants of health. Experts also attribute Indigenous communities’ difficulty accessing end-of-life services to a lack of cultural sensitivity among health care professionals.

“For the communities for whom you want to improve access to quality care, bring those folks into the conversation. Don’t make assumptions, ask them for help and to be a part of the solution,” said Dresang. “The other thing is to bring other organizations into the conversation. All of this work is not possible without collaboration and partnership. Don’t work in a silo or in isolation.”

Hospice providers have increasingly sought avenues to better understand reasons leading to reluctance among these groups to seek out hospice or palliative care. Fear and mistrust of the overall health care system, as well as a lack of understanding and awareness, represent some of the largest known barriers to hospice and palliative care.

In addition to closing racial gaps in hospice care, many hospice providers are ramping up staff sensitivity training, education and awareness as not only a crucial part of reaching a more diverse patient population, but also an avenue to sustaining a shrinking hospice workforce.

A majority of 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. More than 70% of organizations surveyed in an Axxess report of home-based and hospice providers indicated that they would increase resources in 2021 for staffing diversity, equity and inclusion.

Agape Care Group is among the providers devoting more resources to diversity. The company recently partnered with BCS & Associates Consulting (BCS) to enhance its focus on diversity and inclusion across the organization.

Agape is a portfolio company of the Chicago-based private equity firm The Vistria Group. The hospice serves more than 1,500 patients across South Carolina and Georgia and employs roughly 900 employees. The company recently launched an organization-wide initiative in collaboration with BCS that will focus on cultivating diversity and cultural competency among staff.

Among the program’s goals is improving understanding of structural inequality and advocating for the respectful inclusion of any individual regardless of their racial, ethnic, gender or other identities.

Located in South Carolina and Virginia, the primary focus for BCS is to address issues of social injustice, and providing resources and opportunities to help marginalized communities while breaking down institutional barriers.

“As Agape Care works to honor our core value of pursuing diversity, we are proud to partner with BCS & Associates Consulting Firm. Our goal as a company is to bring topics of diversity, equity and inclusion to the forefront of conversation,” said David Powell, mission officer for Agape Care. “Through our partnership, we hope to continue to move forward as our workforce and patient population grows.”

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