Hospice Sustainability Rides Hand in Hand With Diversity, Equity and Inclusion

The business case for diversity, equity and inclusion in hospice care

The drive for greater diversity, equity and inclusion in health care is more than a flash in the pan. It could impact hospices’ sustainability as well as their access to patients.

Initiatives to reach underserved populations have been a rising priority among hospice providers. Spurred by incidents of social injustice and inequities exposed by the pandemic, more than 70% of hospice, home health and private-duty providers surveyed by Axxess last year indicated that they would increase resources for these efforts. 

However, these efforts must be designed to ensure they stretch beyond the scope of temporary programs to make lasting change


Invest in long-term change

A focus on diversity, inclusivity and equity can bear weight on a hospice’s financial performance.

While health care providers have a moral responsibility to ensure underserved populations have access to care, these groups also represent an untapped market for their services. Both hospices and patients stand to reap the benefits of getting it right, but missing the mark can adversely affect a provider’s bottom line.

Organizations that focused on ethnic and cultural diversity outperformed others in profitability by 36% during Q4 2019, according to a global study by McKinsey & Company. The research included more than 1,000 large companies in 15 countries.


Likewise, gender-diverse companies were 48% more likely to outperform competitors, according to the study.

Health equity is also gaining new importance when it comes to reimbursement, particularly through value-based payment model demonstrations.

The Center for Medicare & Medicaid Innovation (CMMI) last year announced a “strategy refresh” that included a renewed focus on health care equity in payment model design. Among the first new models to use this approach is the Accountable Care Organization Realizing Equity, Access and Community Health (ACO REACH) program.

Set to launch in 2023, ACO REACH includes health equity benchmarks designed at improving access to health care. Participating providers must develop and implement robust health equity plans that identify underserved communities and lay out initiatives aimed at measurably reducing health disparities.

ACO REACH is just the beginning. Hospices that seek to participate in any number of future alternative payment models may need to sharpen their focus — and take real action — on diversity, equity and inclusion.

Where hospices swing and miss in diversity

Diversity-building programs are a step in the right direction, but to truly be effective these efforts cannot be temporary or isolated to a few dedicated staff.

Principles of equitable and inclusive care must be woven into an organization’s fabric, according to Keith Everett, CEO of Louisiana-based Hospice of Acadiana Inc.

“When you develop a program, it means that potentially it may stop,” Everett told Hospice News. “We have to get out of the mindset of developing a program and into making this part of our cultural fabric.”

Hospices’ diversity efforts often focus on bridging racial, cultural and ethnic divides — and with good reason. Asians, African Americans and Hispanics in 2018 represented only 20% of Medicare hospice patients, while the remaining 80% were Caucasian, according to National Hospice and Palliative Care Organization (NHPCO).

These disparities must be addressed, but the work does not end there.

While communities of color have faced historic mistreatment, bias and stereotypes leading to mistrust in the health care system, a host of other underserved populations have as well. These include LGBTQ+ communities, homeless populations, individuals with disabilities and those with serious mental illnesses.

Other underserved populations include those who dwell in rural communities, low-income families and pediatric patients.

To achieve greater health equity, hospices need to cast a wider net.

They may also need to foster greater diversity among their staff, the lack of which has contributed to the barriers encountered by underserved populations.

This, again, offers benefits to both patients and providers. Greater representation among employees was an indicator of strong financial performance, the McKinsey & Company study found.

But hospices may be lagging behind other health care sectors in this regard.

About 93% of home health providers already have implemented goals around hiring a more diverse workforce, compared to only 67% of hospices, according to the LeadingAge/BerryDunn National Healthcare at Home Study. The organizations recently polled more than 1,000 home health and hospice agencies from across the country.

Some provider strategies bearing fruit

Nevertheless, some hospices have developed strategies that they say are proving effective.

Among these is deepening their community engagement and partnerships, along with developing more representation in marketing, public awareness and education campaigns.

Data can also be an important tool.

Hospice is a data-rich industry. Providers can leverage this information to identify unmet patient needs, with the caveat that the insights gleaned may be limited in scope.

These data can also help providers better determine financially viable mechanisms for improvement, according to Robin Stawasz, program development executive at Acclivity Health.

“To achieve health equity, we need to leverage technology to locate and eliminate barriers to care – which will encourage good health, and reduce unnecessary high-cost care utilization across a community,” Stawasz told Hospice News sister publication Home Health Care News in an email.

Rather than a focus on data solely around utilization, providers need to assess the immediate and future care needs of underserved populations, Stawasz continued.

Community outreach can be a key to understanding the depth and scope of these needs, such as forging lasting connections with faith organizations and local advocacy groups.

This can be challenging for hospices that are often strapped for manpower and resources amid widespread workforce shortages. Many are turning to volunteers to form and sustain collaborative partnerships in underserved communities. However, much like their paid employees, the base of volunteers has dwindled under pandemic pressures.

Whether paid or volunteer, individuals conducting this outreach need training and education to do this effectively. This is another area in which a number of hospices have risen to the occasion, increasingly mobilizing diversity education to increase awareness, breakdown staff misperceptions and help them deliver more equitable quality of care.

Some have woven these concepts into the fabric of their onboarding and ongoing employee training, while others have incorporated inclusion principles into their care delivery processes.

For example, expanding their understanding of the parameters of a patient’s family and caregiver support system. The meaning of the word “family,” for example, is often interpreted as individuals connected biologically or through marriage. But these can vary across different cultures, as well as in LGBTQ+ communities or those experiencing homelessness.

To foster sustainable progress, hospices should look within at their own organizational culture, according to Altonia Garrett, executive director of AccentCare Inc. Garrett also serves on the board of directors for the Hospice & Palliative Care Network of Maryland and chairs its Diversity Committee.

“I’ve seen companies try to go out and do outreach, but they don’t look inside and see how they can change,” Garrett told Hospice News. “They’re quickly ready to put out things to the community, but changing your organization is an internal, intentional culture shift that has to happen as well. Work inside first, and then you can deliver on the outside. You can’t practice what you don’t preach.”

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