Disparities in hospice enrollment are not likely related to access, new research shows

The results are published in the current issue of the Journal of Palliative Medicine.

"Despite a significant increase in the availability of hospice services during the past decade, the majority of Americans die without hospice care," said Melissa D.A. Carlson, PhD, Assistant Professor of Geriatrics and Palliative Medicine at Mount Sinai School of Medicine. "Our data show that proximity to a hospice provider is not a likely barrier to hospice enrollment, as the vast majority of Americans have a hospice nearby."

Studies have shown that enrollment in hospice helps address end-of-life concerns facing patients and their caregivers. Hospice services offer symptom management, medication delivery, home crisis intervention, and psychosocial support during one of the most difficult and emotionally demanding phases of the patient's illness.

Dr. Carlson's research team studied data from the 2008 Medicare Provider of Services data, U.S. Census data, and geographic mapping software. Census tract characteristics evaluated included population per mile, population over the age of 65, median household per capita income, percentage over the age of 18 with less than a high school education, black population percentage, and census region. The team determined that 98 percent of the U.S. population lives within 60 minutes of a hospice, and 88 percent live within 30 minutes from one.

The average number of minutes between a community center and a hospice was 15 minutes. The number of minutes to the nearest hospice was lower in communities with several characteristics, including: higher population per square mile, higher median household income, lower percentage with less than a high school education, and a higher black population percentage. Communities with higher percentages of the population who are black are more likely to have geographic access to hospice, but previous research has shown that people who are black are less likely to use hospice compared with people who are white.

"Our data suggest that the growth in the number of hospices since 2000 has improved access to hospice care as the closest hospice for approximately one-third of the population, in both rural and urban areas, is a relatively new hospice, certified by Medicare since 2000," said Dr. Carlson. "However, more research is needed to determine why more patients and their families are not under the care of a hospice at the end of life, including hospice admission criteria and patient financial and cultural factors that may present barriers to hospice use."

Co-authors on the study were R. Sean Morrison, MD, Professor, Geriatrics and Palliative Medicine, and Ms. Qingling Du, Senior Research Analyst, both of Mount Sinai School of Medicine and Elizabeth H. Bradley, PhD, Professor of Public Health at Yale University.