‘Moving the Mindset’ of Equitable Hospice Access

Hospices’ diversity and inclusion efforts have hit several barriers in recent years. Policy reform and more person-centered care integration represent two significant propellants toward improvement.

Today’s providers often lack sufficient resources to improve health equity in substantial and sustainable ways, said Dr. Kimberly Curseen, board president for the American Academy of Hospice and Palliative Medicine (AAHPM). Workforce shortages, challenging economic conditions and inefficient reimbursement are among hospices’ greatest challenges, she stated.

Hospices need structured community outreach processes that measure cost, outcomes and quality improvements across diverse patient populations, Curseen indicated. Having dedicated health equity resources would go a long way to better understanding the range of both unmet needs and under-reached service regions.

“What you do for the least of us is what you do for all of us,” Curseen told Hospice News. “We need to move the mindset. If you create and design something that can be accessed by people who will have the most difficulty, then everybody can access it. Anytime we are patient-centered and flexible in care … that allows for all of us to define what quality is.”

Health equity improvement has been complicated in recent years, according to Curseen. She is a board-certified in internal medicine, geriatrics, and hospice and palliative medicine physician. Curseen is also director of supportive and palliative care of outpatient services for Emory Healthcare and an associate professor at Emory University’s Palliative Medicine Program.

Among the issues is that some companies in the health care space and beyond have pulled back the reins on diversity, equity and inclusion (DEI) initiatives, Curseen said. This trend is exacerbating barriers and challenging providers’ ability to better reach underserved patient populations.

“DEI has become a difficult word in which we place a lot of emotion,” Curseen said. “If diversity, equity and inclusion is not okay, then what they’re doing is no longer taking care of those people and those people are not included at the table. In order to understand how you’re going to deliver more equitable care to different populations, you have to start with asking not only the providers, but also the patients about what is actually going to work. What are their values, their barriers and solutions in communities with very poor resources?”

Race has represented one of the largest barriers to hospice and palliative care, with providers seeking to better understand the significant challenges.

White seniors have historically represented the bulk of hospice patients. About 85.8% of all Medicare hospice decedents were white in 2024, according to the 2025 Hospice Care Chartbook from the Research Institute for Home Care. An estimated 8.3% of decedents were black that year, with 1.8% Hispanic, 1.4% Asian and 0.4% North American Native, the report found.

Policy reform is essential to removing some of the common barriers preventing better utilization among underserved populations, according to Brittany Chambers, director of health equity and special initiatives at the Center to Advance Palliative Care (CAPC).

Overhauling certain requirements under the Medicare Hospice Benefit could move the needle closer to health equity improvement, Chambers said during the Annual Assembly of Hospice & Palliative Care, an event by AAHPM and the Hospice and Palliative Nurses Association (HPNA).

The hospice benefit should be more “universally designed” to allow for expanded upstream access, Chambers said. For instance, pediatric patients are able to receive curative treatments alongside hospice care, whereas adults cannot. If adult patients did not have to forgo curative care, it may impact their decision making at the end of life, according to Chambers. This could mean that more adults across diverse racial and cultural groups would choose to use hospice.

“We need to advance policy reforms that address inequities in hospice access and enrollment,” Chambers said during the assembly. “When it comes to black and white patients, there may be different responses to the hospice requirements, leading to why we see disparities. That requirement to discontinue curative or disease-directed treatments is a key drive to the difference. When we do enable models of concurrent [care], we do see a narrowing of those enrollment gaps.”