Seasons, AccentCare VP: Hospice Education Essential for Underserved Communities

The Seasons Hospice & Palliative Care/AccentCare has appointed Nicole McCann-Davis as associate vice president of health equity and access. In this newly created position, she will oversee the company’s efforts to foster equity, diversity and inclusion among staff and its patient population. Seasons and AccentCare merged in late 2020, but the two segments have retained their original branding. 

Diversity initiatives are a rising priority for hospice providers. More than 70% of an Axxess survey of home-based care organizations indicated that they would increase resources in 2021 for staff diversity, equity and inclusion, with 91% of respondents from larger organizations indicating that they are focused on the issue and addressing it.

McCann-Davis brings more than 15 years of marketing and communications leadership experience to her new role. Most recently, she served as Seasons’ director of communications and multicultural affairs. She also chairs the National Hospice & Palliative Care Organization (NHPCO) Diversity Advisory Council.

McCann-Davis sat down with Hospice News to discuss Seasons’ and AccentCare’s strategies for addressing equity, diversity and inclusion and the range of communities that are often underserved in hospice and palliative care.

What are some of your top priorities as you come into this new role?

The way that I approach health equity in general is by looking at it through a few different lenses. There is certainly education, which I think is incredibly important especially when it comes to our staff. I think it’s important that we are educating our staff and helping with their own personal and professional development to ensure that they can meet patient needs, and the needs of their families as well.

Also, there is community education, which comes along with partnerships and in that all-important relationship building that needs to happen in the communities to ensure that they see us as a partner and a resource. Because if they don’t, it’s challenging for them to truly understand what resources are available to them and the options that are available to them.

There are way too many people who are dying and pain who are dying alone, without the support that hospice and palliative care can be held to offer. That’s really my top priority: making sure that we are truly meeting the community where they are.

The third priority for me is really figuring out how we can ensure that we are creating additional opportunities for employees, and also for those in the community when it comes to employment. When we talk about health equity, it’s very important that we have people within our staff who reflect the communities that we want to serve. Having a diverse staff is never going to be a negative. It’s important that we’re all exposed to different people. It helps us to have a better understanding of one another and to grow and develop as individuals as well. But it has a very great impact on the patient experience where they also have a certain level of comfort.

I’ve been partnering with our human resources team, our recruiters, and our volunteer department as well, because we want to make sure that we are recruiting volunteers from the community. We are not just there to serve the community, but also to create jobs within the community. I was first exposed to hospice as a volunteer at 16-years-old. If it weren’t for that experience, I may not have known what hospice was. It helps bring everything full circle where people are more aware of what their options are for a better end of life experience.

You mentioned partnerships for community education. What types of groups or organizations would you partner with?.

One thing we do is have many partnerships with different faith-based organizations. We will partner with different organizations to sasak how we can be a resource for them, depending on the community needs. Oftentimes, we know that many people are not having conversations around their end-of-life planning. We will partner with a church, for example, where we can do some advanced care planning training.

We also understand that we can’t just walk right in and say, “put us in front of your entire congregation.” We take an approach where we meet with faith-based leaders first. We also train the trainer so that they know how to talk to members of their congregation about advanced care planning, what that can look like and what their options are. Our goal is always to empower the communities that they can make the decisions that are best for them.

Can you describe some of the conditions within the health care system that contribute to disparities in hospice and palliative care?

I think that the hospice and palliative care system as a whole certainly provides excellent care, you know. It’s really about holistic care. However, oftentimes, by the time the patients get to us, some of them have not had a positive experience before they got to this stage in their life.

Whether it’s secondary trauma, and they are hearing these stories of generational trauma that has happened, these things really can contribute to that lack of trust in the health care system before they even get to the point where we offer them all these wonderful services. If you don’t trust the system, then it can be challenging to believe that this is real.

For some, having people come into their homes can be sometimes uncomfortable. Many communities rely very heavily on their families. We try to help them understand that the hospice team is not there to replace your family. We are there to support you and your family; we are an extension. Most importantly, there is the bereavement service that comes after a patient has died.

It’s really that trust in the health care system, unfortunately, that can be very challenging. People don’t always trust that it’s going to be covered by Medicare. They need help understanding what those options are, and making sure that they don’t feel like they’re being nickeled and dimed with health care bills. We work to make sure that we are there building trust with them.

That may take time. It may not be a quick conversation. But if it takes an hour in order for them to be comfortable, versus a 10 minute dialogue, then you need to invest however long it takes to make sure that their needs are being met.

What are some of the barriers that come between underserved populations and hospice providers?

When we think about underserved populations in particular, that can look like many different things.There can be a language barrier. When we think about hospice and how that word translates in different languages, it doesn’t always translate the way that it is intended. That’s why it’s important that we diversify our staff. You need to have people who are able to communicate. In any type of care, it always comes back to that communication.

We go and see patients who are homeless. If you are living under a bridge, we are coming to you wherever you are and where you feel most comfortable.

Barriers can pertain to language. It can be just a general understanding. Logistics and geography that can be barriers as well. Transportation is always a challenge when we think about the social determinants of health. What I love about hospice in particular is that it is a type of care where we’re there to support the needs of the patient. It doesn’t involve coming into a doctor’s office for a 10-minute visit. We need to go where the patient is. We have to go above and beyond to make sure that we fully understand their needs no matter what that takes.

Can you discuss any of the strategies you plan to use to reach these patients?

Education is certainly a big one. We are doing that across the board. We’ve actually made it mandatory that every single one of our sites has to include outreach to underserved communities part of their quarterly strategies. We can’t just rely on our traditional referral sources or traditional ways of meeting patients where they are. It’s important that we are always seeking creative solutions to ensure that we are meeting every single eligible patient possible. That’s a really big part of our strategy.

As we dig deeper, at each individual site we are looking at how we are educating our employees, but also at those community relationships. I can’t stress enough the importance of being consistent in the communities. We can’t build a relationship with the community by doing one event and then disappearing.

When we talk about diversity and inclusion I think most of us immediately think of matters of race and ethnicity. Is there are larger view that providers should take?

We certainly think about those who are economically disadvantaged. That is a huge underserved area for a variety of reasons. Those who live in more rural areas as well, because they may not have transportation piece may make it challenging to access consistent health care. The LGBTQ+ community is a very large group who I would consider underserved with end-of-life care. We are very much focused on how can we best reach the LGBTQ+ community, and in particular the transgender community,

There’s not a lot of research on the needs of the trans community at the end of life. It’s very important that we find out all the data we can in order to provide the best possible care. We also look at different religions. At Seasons and AccentCare we have a Jewish hospice program.

Diversity, equity and inclusion is not always Black and White. It’s Englishas a second language, religion, gender identity, people in rural areas.

Can you talk about how you’ll be building diversity among your staff?

We have a few different projects in the pipeline. We’ve been partnering with historically Black colleges and universities, and junior colleges as well, to do virtual career fairs throughout COVID-19. We will do this in person when we are able to do that again. We’re really just trying to figure out how we can reach communities where they are.

It’s also very important that we find opportunities to further develop the future leaders within our organization. One thing we’ve done over the past year is roll out the Pathways program within Seasons. That’s something that I was able to spearhead along with our vice president of human resources. This is an internal mentorship program where we pair mentors with our frontline employees. In one instance we had a hospice aide who was paired with the CEO of our organization.

We find ways to pair people up with our executive leadership team who have so many years of experience and guidance. Finding those opportunities where we can help to elevate and develop our staff is incredibly important, because we want them to be with the Seasons and AccentCare family for a very long time. In order to do that, it’s important that we invest in their future.