Recent government pullbacks on diversity, equity and inclusion stand to exacerbate health disparities among underserved patient populations during a time of rising demand for end-of-life care, according to hospice executives.

The White House thus far this year issued several executive orders that have ramped up the nation’s immigration enforcement policies while also aiming to reduce or eliminate DEI-related activities.

These changes have thrown a wrench in the progression of health equity in the hospice space, according to Victor Couzens, owner, founder and CEO of Mahogany Home Health and Hospice. The updates pose both challenges and opportunities for hospice providers seeking to improve access, trust and breakdown misunderstandings among minority communities, Couzens said at the Hospice News ELEVATE conference in Florida.

“[These changes] will certainly bring greater mistrust of the health care system as a whole [and] it will probably also alienate people who really need the hospice benefit,” Couzens told Hospice News at the conference. “It’s also an opportunity, because we all have to ask ourselves, ‘Is DEI a policy or is it a mindset?’ On one hand, there will be some people who will use it as an excuse to not do the humane thing. But on the other hand, there will be people who say we don’t need a policy [and] we don’t need permission to just simply do the thing that is right.”

DEI policy’s impact on patients

One key development is the establishment of the Department of Government Efficiency (DOGE). The department’s oversight to date has focused on activities related to diversity, equity and inclusion, financial assistance for foreign aid and nongovernmental organizations and reducing the overall federal workforce, among others. The DOGE aims to eliminate federal DEI programs and reduce government spending in concert with the White House Office of Management and Budget (OMB).

A recent executive order outlined the Trump administration’s goals to terminate DEI policies, programs, preferences, employment practices, spending and activities across the government, which the president characterized as “illegal” and “discriminatory.”

The growing prevalence of DEI programs in recent years has become critical in reducing health disparities among terminally and seriously ill patients, said Alicia Bloom, senior vice president of operations at Empassion Health. These programs have brought “impactful” progress in driving access and awareness around end-of-life care options, Bloom said at the ELEVATE conference.

New DEI policy changes are hindering the outlook of hospice utilization and access, Couzens indicated. The policy changes mean that hospices need to revamp their public outreach and patient engagement approaches. Hospices need to be more invested in forming collaborative community partnerships that include a wider range of minoritized groups, he added.

“The hospice space … is really beginning to see a lot of success and a lot of fruit among the agencies that are not afraid to roll their sleeves up and just get out in their community and get to know people,” Couzens said. “[It’s] not only showing up to give the goals-of-care conversation, but truly being partners with these communities. It’s going to be us [seeing] these things that are happening that people are very upset and concerned about. There’s a way that we can use these as opportunities to really build trust.”

Hospice News photo by TBAR Productions.

Hospices are navigating several unknowns in future government policies related to inclusive care, according to Dr. Claritza Rios, chief medical officer of By the Bay Health.

Greater advocacy at local and federal levels is needed to move the needle toward change, Rios stated. Policymakers need more clarity around the potential ripple effects of recent DEI setbacks, which have led to heightened distress among patients and providers alike, she said.

The policy changes have hospices working harder to reach underserved communities and dispel common misconceptions that serve as large barriers, according to Rios.

“It’s a really scary time now, and we just have to be different and do the work,” Rios told Hospice News at the ELEVATE conference. “We really need to engage in truly systemic change to ensure that people buy into what we’re telling them as a right plan of care. Many minority communities often feel that we’re taking things away in end-of-life care. We are discontinuing things that are no longer helpful, but that doesn’t necessarily align with what they’ve been experiencing all their life.”

DEI policy affects hospice workforce

Another policy change coming down the pipeline included an executive order allowing regulatory authorities to seek actions that identify and publicize information about undocumented immigrants, pursue expedited deportations and impose civil fines and penalties. The policy is aimed at protecting “the public safety and national security interests,” the executive order stipulated. Failure to comply with legal obligations in some cases may result in individuals being subject to civil and criminal enforcement.

A recently issued executive order has since allowed state and local law enforcement agencies to “relentlessly pursue” individuals and stipulates that in many regional jurisdictions DEI policies “divert their attention” from fighting crime.

The immigration policies could have a potential chilling effect on the hospice workforce, according to leaders in the space. Providers have voiced concerns of increased staffing shortages as immigrants fear arrest, deportation or detention in hospice facilities, hospitals and palliative care clinics.

Immigration policy changes may impede greater representation of underserved communities in the hospice workforce, Bloom said. Hospices need thoughtful consideration when shaping inclusive hiring practices that foster improved engagement among diverse communities, she stated.

Patients and their families value having providers who identify, understand and reflect their values, beliefs and culture, Bloom added. The new policies may challenge the ability to strengthen recruitment and patient reach among underserved groups.

“What I worry about is [that] some of these changes might impact how our workforce is built and grows,” Bloom told Hospice News at ELEVATE. “Does your team look like the community that it is serving? If we are making changes … that might make it more challenging for individuals to enter higher education and training programs, especially if they are from a community of color or an underserved, under-resourced community socioeconomically. How does that impact our teams?”