Racial Disparity in Hospice Enrollment.

From HFA's Hospice and Caregiving Blog, a look at the racial disparities in hospice enrollment. The fact is that minorities including blacks and hispanics enroll in hospice much less often than whites, even though they suffer some illnesses at a higher rate.

Most of the reports I've seen coming out about this simply note the facts and statistics but make little speculation as to why. It is the why that is most important if we wish to ensure that all Americans have a chance to die the way they want to.

I can guess at a two primary reasons: fear of the medical community after decades of what these groups may rightly call discrimination against the value of minority lives; and a higher prevalence of devout faith which studies have shown compels individuals to agree to aggressive care until the end of life.

Layer these two factors over the impression in larger society that enrolling in hospice is "giving up," and the chaos of last summer that, whether we like to admit it or not, has changed the way the media and society view hospice, advance directives, end of life planning. For minorities who already have less resources for caring for the dying in their homes and a lower rate of participation in their own caregiving (because they tend to use clinics where a relationship with a doctor is not fostered) and you have a perfect storm of challenge for dying minorities and their families.

As in ever other sector of society, the poor and minorities suffer the worst outcomes because of marginalization, lack of access and information and poverty. Health care is no exception. In fact, it is one of the primary failures of our society.

The March 8 issue of the Archives of Internal Medicine reports that among patients with advanced heart failure, blacks and Hispanics are less likely to enroll in hospice care. Researchers from the Institute for Aging Research of Hebrew SeniorLife and Boston University School of Medicine adjusted for sociodemographic, clinical, and geographic factors and found that blacks were 41% less likely to use hospice care than whites, and Hispanics were 51% less likely.

Researchers looked at 98,258 beneficiaries who were not enrolled in 2000, and whether or not they entered hospice in 2001.

From the Ivanhoe Newswire:

Concerning experts is the fact that blacks develop heart failure at a significantly higher rate than Hispanics and whites, mostly because of their increased rates of diabetes and high blood pressure. A recent study revealed young and middle-aged blacks suffer heart failure 20 times more than white individuals in the same age group.

"Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization," Jane L. Givens, M.D., M.S.C.E., lead author and a scientist at the Institute for Aging Research in Boston, was quoted as saying.

Earlier studies show cultural belief and values play an important role in hospice use, but Dr. Givens says hospice care must be culturally sensitive to work.

Read the Cardiology Today and MedPage Today reports of this study.

HFA's 2009 initiative focused on Diversity and End-of-Life Care, and also included this special report on African Americans and End-of-Life Care. The report offers explanations as to why hospice, historically, has not been a choice for many African Americans, looks at grief and the African American community, and suggests ways to reach out to African Americans who are making end-of-life decisions.