More hospices nationwide have increasingly recognized the value proposition of expanding their reach into untapped and underserved populations and geographic markets.

Aside from increased access, census volumes and quality, health equity’s return on investment can also include a better recruitment and retention outlook, according to David Turner, vice president of special projects and initiatives at St. Croix Hospice, which serves 10 Midwest states. Turner is also CEO and partner of Nashville-based Heart’n Soul Hospice.

Hospices stand to benefit from recruiting and retaining a more ethnically diverse base of interdisciplinary workers and c-suite executives, Turner said at the Hospice News Elevate conference in Washington D.C.

“A big part of this is the bottom line that a lot of hospice providers recognize that market share is something everybody is fighting for and so they want to become more aggressive in working in [underserved] communities,” St. Croix Hospice’s Turner told Hospice News at the conference. “A risk to health equity and inclusion is apathy. What I would like to see is more folks who look like myself in senior leadership roles within organizations.”

St. Croix Hospice is a portfolio company of the private equity firm H.I.G. Capital.

Hospice staff teams with greater representation have helped operators break down common barriers to access and provide more culturally appropriate end-of-life care, Turner said. Diverse hiring practices can also carry positive financial and operational impacts, he indicated.

“With health equity and diversity, we’re all about growing our census. But we should also look at who we’re hiring, where they are and what spaces they live and operate in,” Turner said. “This impacts your bottom lines [because] hospices all over are struggling with staffing issues. So, if you can reach out to new communities that maybe aren’t looking at hospice as a potential career path, not only does that give you entry into a new community … [it also allows you] to have ‘in-reach’ of folks doing outreach with people they see every day who are part of their community.”

Hospice News / Merz Photography

Greater opportunities exist for hospices to improve health disparities, according to Teresa Lin, vice president of cultural market development at VNS Health.

Having a comprehensive approach to care delivery and addressing patients’ nonmedical needs is key to improving health equity initiatives, Lin said at the Hospice News conference. This involves establishing relationships with organizations in underserved communities, she indicated.

“It’s important for an organization to create a very comprehensive plan in how they work very effectively with some of the key community-based organizations,” Lin told Hospice News. “When we talk about health equity, do they have access to nutritious food? What about transportation and safe housing? All of those are important. I’m glad to see that there’s a focus on that, because that really gives you a holistic approach to how we can serve this population at the end of their life.”

Developing a more inclusive end-of-life care delivery model involves investing in ongoing staff education on culturally sensitive and appropriate care, as well as teaching staff to assess and address a range of psychosocial and social determinants of health needs, Lin stated.

Hospices seeking to improve disparities also need to pour resources into stronger referral relationship development with health care providers operating in underserved communities, Lin added. The referral efforts can go a long way to improved access, longer hospice stays and quality outcomes among these populations, she stated.

Hospice News / Merz Photography

VNS Health’s service region spans the New York City area, including four surrounding counties. The New York-based provider offers home health, hospice and palliative care, as well as behavioral health and personal care services.

VNS Health has established three community centers in underserved areas of its service region. The company’s bilingual staff at each center play a pivotal role in helping underserved populations better understand and navigate the health care system, including hospice and palliative care services.

Though operating the centers represents a financial and operational lift for staff and management, they help connect seriously ill patients and their families with much needed support within their community, Lin said. VNS Health has seen improved care transitions and coordination among its service regions with underserved communities, she added

“There is lots of education going on besides in the community, but also with the physician groups,” Lin said. “With an internal investment, we actually saw a 44% increase of our referrals coming in from the physician channel. The [return on investment (ROI)] is about building trust earlier in this community. A key element is embedding ourselves in the communities to build that trust, because once you have it, it’s so much easier to connect them right to the health care system. That investment definitely paid off.”