Who Wants Hospice: Racial Disparities in Who Receives End-of-Life Care

According to a report by the California HealthCare Foundation, ethnic minorities enroll in hospice care at lower rates than whites. Only six percent of hospice patients were African-American in 2004. Four percent were Asian-American, 15 percent were Latino, and 74 percent were white.

Medicare admissions requirements are thought to be at least partially responsible. For Medicare funding, a hospice patient must forgo all curative treatment, including chemotherapy and dialysis. Ethnic minorities are thought to be more likely to pursue aggressive treatment until the death.

Also, African-Americans are more concerned than other groups about finding caregivers who will respect their culture. White families are more concerned about pain alleviation, while cost of care is the primary concern for Hispanics and Asians.

The report concludes by recommending that (1) Medicare regulations be reformed to allow aggressive treatment concurrent with hospice care; (2) Hospice employees be trained in cultural sensitivity; and, (3) emergency departments expand their bereavement services because ethnic minorities are more likely than whites to die in a hospital setting.

Readers who would like to learn more about being a culturally competent caregiver should mark their calendars for the of spring of 2009, when Hospice Foundation of America will host its 16th annual teleconference: Living With Grief: Challenges of Diversity.