Hospices have been among the providers working to close gaps in equitable care among underserved communities of color. As diversity initiatives spiked in recent years, providers have grappled with challenges in raising awareness and increasing access. Community partnerships are becoming a key stepping stone along the avenue of improvement.

Building sustainable and long-term strategic relationships have become essential to bringing hospice and palliative care to underserved communities. Collaborating and communicating with community organizations is paramount to understanding the issues rooted at racial divides in access and awareness of end-of-life and serious illness care, according to Nathan Goldstein, M.D., professor of geriatrics and palliative medicine for the Icahn School of Medicine at Mount Sinai. Goldstein also previously served as president of the American Academy of Hospice and Palliative Medicine (AAHPM).

“When we think about creating the best quality of care for our patients and families, it’s making sure that our providers really understand more around diversity, equity and inclusion,” Goldstein told Hospice News. “It’s important to make this a priority to think about diverse backgrounds and perspectives and truly include them and embrace them. We need to really work to listen to all the voices of those with whom we work with in staff, and for the patients and families that we serve.”

The National Hospice & Palliative Care Organization reported that in 2018 more than 80% of overall Medicare hospice patients were Caucasian, while African Americans, Asians and Hispanics made up less than 20% combined. Though health care disparities have long plagued the United States, in recent years issues of racial and socioeconomic equity have come to the forefront in the hospice community, largely due to civil unrest in 2020 and COVID-19 exposing more cracks in the system.

A growing number of hospices have pursued diversity initiatives, often focusing on public outreach and education to raise awareness.

In a recent Hospice News survey, the need for greater public awareness and education regarding hospice and palliative care was close to the top of the list of challenges that hospice providers anticipate this year, second only to staffing shortages.

Though the awareness issue was right behind staffing in terms of the highest numbers, a large gap existed between the two. Upwards of 67% indicated that staffing was their greatest challenge, and 12% of respondents named raising awareness about the value of hospice as a priority in 2022.

Community partnerships represent a growth opportunity for hospices, including when it comes to palliative care and advance care planning programs, according to Grant Smith, M.D., hospice and palliative physician and clinical assistant professor at Stanford Medicine.

“Partnerships potentially between health care institutions and community-based organizations, those have been most proposed as potential solutions to help address that awareness and knowledge gap in the general population [and] the community about palliative care and those gaps that exist in advanced care planning,” said Smith during the AAHPM and the Hospice and Palliative Nurses Association (HPNA) Annual Assembly.

As hospices navigate community ties, knowing where and how to start has been a large hurdle to cross. As providers venture further into underserved communities, an important first step is to deploy targeted initiatives rather than expanding efforts across the board, according to Ashley Bragg, director of Stanford Palliative Care Center for Excellence.

“Some of the things we’ve learned in working with the community the last almost three years is that we threw everything at the wall to see what would stick, and we probably wouldn’t do that again,” said Bragg during the AAHPM and HPNA event. “There’s low-hanging fruit that is enticing, but it’s not necessarily the right direction to go and could distract from the bigger goals. Instead, I’d really recommend identifying through numerous ways the community you want to serve, and then explore the organizations that are already serving that community.”