Hospices’ public outreach efforts have evolved in recent years, with providers finding new strategies to dispel myths that have long impeded access to care.

Nearly half, or 49.1%, of all Medicare decedents utilized hospice services in 2022, reported the National Alliance for Care at Home. National hospice utilization rates have hovered around this vicinity for the past decade, with 44% of decedents receiving these services in 2010, the Alliance report found.

This trend demonstrates that a general public awareness of hospice care exists, according to Phillip Ward, president and CEO of Florida-based Community Hospice & Palliative Care. However, misconceptions about patient eligibility and the types of interdisciplinary services available remain as common barriers to expanded understanding and utilization, Ward stated.

“We are typically attempting to overcome preconceived impressions that often associate hospice with brink-of-death care, rather than an understanding of the comprehensive services available to both the patients and families as the disease is advancing over the final several months,” Ward told Hospice News in an email. “We must be better at positioning hospice care as a part of improving their lives, rather than simply being present at death.”

Overcoming boundaries

Providers have long fought to improve understanding of their services since the Medicare Hospice Benefit was established in 1983.

Many families are unaware that hospice care is available to their terminally ill loved ones with a life expectancy of six months or less, Ward said. Some conflate these services with care provided to assist or hasten death, while others don’t understand what is included in the hospice benefit, he added.

Misunderstandings about hospice have led to short stays during which patients and their families are not able to reap the full scope of interdisciplinary, person-centered care — for either their loved ones or themselves, Ward indicated.

The average length of stay among hospice decedents was 95.3 days between 2021 and 2022, according to a report from the Medicare Payment Advisory Commission (MedPAC). Median length of stay rates reached 18 days during that time frame, the MedPAC report found.

Hospice is about much more than assisting patients and families through the dying process, according By the Bay Health CEO Skelly Wingard. The California-based nonprofit emphasizes how its hospice program improves quality of life, Wingard stated.

“There’s sometimes a perception that hospice is just about dying — but it’s actually about living,” Wingard told Hospice News in an email. “In hospice, there is hope and finding meaning for patients and families by having the space to engage in important conversations, find comfort and create reconciliations at the end of life.”

Recognition has grown around the issues that terminally ill patients face, including the celebration of November as National Hospice and Palliative Care Month, which was established in 1978 by then President Jimmy Carter. The federal payment model demonstration that led to the founding of the Medicare Hospice Benefit began during Carter’s tenure in the White House.

Extended well beyond six months, Carter’s hospice stay (currently around 19 months in length) has helped underscore the benefits for patients who enroll in hospice earlier in their disease trajectory.

Evolving strategies

Hospices’ public outreach strategies have evolved over the years to foster earlier engagement with patients and their families. One avenue has been to highlight the positive experiences of other community members who have received their services, and the impact it had on the quality of life for a patient and their caregivers, Ward stated. This can be a particularly effective tactic when seeking to overcome misconceptions among underserved patient populations, he stated.

“We find people want to hear from others who have already walked through their journey,” he said. “Voices that sound like their voice, stories that resonate, and faces that look like their faces — that is especially important when reaching out to traditionally underserved populations and can be an approach that assists in overcoming cultural barriers to care. It empowers people to make decisions and prepares patients and families for the moment when critical choices are needed.”

Other hospices have also found success through similar community engagement strategies, such as Hosparus Health’s ambassador program. The Louisville, Kentucky-based hospice provider engages community partners with personal experiences in hospice to serve as ambassadors who educate others.

The program is an extension of its volunteer outreach efforts and also allows for “extra voices” in the community working to dispel hospice myths, said Tracy Tanner, executive director business development and provider relations at Hosparus Health.

Meeting patients where they are before a need for hospice exists is also important, though challenging, Tanner said.

The hospice provider has employed a few different strategies to expand its reach in underserved communities across its 41-county service area Kentucky and southern Indiana. Hosparus Health has developed a deep bench of community partnerships with senior resources providers, such as nonmedical caregiver agencies, elder law firms, churches or other religious and faith-based groups, Tanner stated.

The hospice has participated in health fairs and hosts Senior Summits, which are community events designed to educate seniors about various aspects of medical, nonmedical, practical, financial and psychosocial support available to them as they age.

“These Senior Summits are basically a way to partner with any senior community resource and invite them to participate and provide details about their resource for aging communities,” Tanner told Hospice News. “We’ve had a lot of success with people gravitating to these events, because we’re always looking for someone else to partner with, whether it’s talking about advance directives, living wills and those types of things. We kind of piggyback on that to then engage as many people as possible. We’ve really leaned into those partnerships.”

The hospice provider spreads awareness through varied communication routes, including greater utilization of social media channels such as TikTok, Tanner stated. Hosparus Health utilizes TikTok to engage a more diverse population, as well as to help educate younger generations and foster more conversations about end-of-life care, she added.

“We’re trying to be as innovative as possible with social media as we can,” Tanner said.

Technology has increasingly become a key component of public outreach tactics, a trend in part fueled by the pandemic when hospices were challenged by social distance requirements. More hospices reached out virtually to connect with patients and their families, including through expanded online grief programs.

Highlighting a wider scope of its virtual programming has been a key to Hosparus Health’s public messaging, Tanner indicated. Featured topics have included practical resources, grief counseling, caregiver support and education, among others.

Service diversification can also be a key to feature in public outreach. Hosparus Health includes details about its disease-specific programs upstream of hospice such as its palliative care services and dementia program. Similar to referral education efforts, it can be important to communicate how these specialty programs can help reduce hospitalizations and repeated utilization of high-cost emergency services, support symptom management and ease care transitions, according to Tanner.

“We provide a lot of public education about these specialized programs, and I think that helps really address more specifically what a patient is dealing with and might have in the moment, rather than their overall advanced illness,” she told Hospice News.

Service diversification has indeed been a top-of-mind issue for hospices seeking to expand their reach, with more providers launching programs in palliative and dementia care, end-of-life doulas and PACE models, or partnering with organizations who provide these services. These programs can be communication gateways to help educate families on their options across the continuum, not only at the end of life, Wingard noted.

Hospices offering a broader range of services have greater potential to engage patients upstream of a critical need and illustrate how their programs help patients manage chronic conditions requiring long-term caregiving support, she stated.

Having strong public education campaigns can also help drive recruitment and retention efforts, Wingard said. By the Bay Health has unveiled an educational initiative aimed at improving clinical capacity amid rising demand.

“To address the current health care workforce shortage and to ensure a thriving workforce to support our rapidly aging and increasingly diverse community in the years to come, we are launching an initiative called Pathways to Care Careers,” Wingard told Hospice News. “This initiative is a partnership with local county education, high schools and colleges to create interest in health care careers, including home-based care.”