Blacks and Hispanics are more vulnerable to low-quality hospice care

Story​ updated​ July​ 7,​ 2017.

Black and Hispanic patients are more likely to receive low-quality care from hospices compared to whites, according to a new study from Rand Corp.

Caregivers for black and Hispanic patients reported lower quality scores as compared to white patients. The patients had less access to timely care and were less likely to report that family members were treated with respect.

The findings are consistent with other studies that compare the quality of treatment between minority patients and whites, the study authors note. Other studies have found that black and Hispanic patients are more prone to poor quality care across most healthcare settings.

It's difficult to know why this disparity exists, but it could be because black and Hispanics are more likely to live in urban and rural areas where healthcare quality is usually poorer, said Rebecca Price, lead author of the study and a senior policy researcher at Rand Corp.

Price and her co-authors analyzed survey responses from nearly 300,000 hospice caregivers who completed the CMS' Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey from April 2015 to March 2016. The caregivers were from almost 2,500 hospices located in all 50 states.

Black and Hispanic patients were more likely to receive care from for-profit hospices than white patients. About 48% of black patients and 52% of Hispanic patients received care in a for-profit hospice versus 39% of white patients. The researchers note that for-profit hospices are more prone to lower quality care compared to not-for-profit hospices because they often use fewer skilled staff members and provide a narrower range of clinical services.

Caregivers of black and Hispanic patients said the emotional and religious support provided by hospice teams didn't meet their needs compared to caregivers of white patients. This was particularly true for caregivers of Hispanic patients, who were significantly more likely to say that they received "too much" emotional support.

Price said it's important for hospices to work to understand their patient populations and their unique cultural needs by offering language translators or working with faith-based organizations to accommodate a chaplain or pastor on-site.

"There are populations within hospices that might be best served by coordination with faith-based organizations," she said.

On a brighter note, the caregivers of black and Hispanic patients were more likely to say they received the appropriate amount of training needed versus caregivers of white patients. Price said it's unclear why this difference existed, but hospice training for caregivers is commonly regarded as better compared to other care settings.

An​ edited​ version​ of​ this​ story​ appears​ in​ Modern​ Healthcare's​ July​ 10​ print​ edition.