While Hospice Care Is Growing, Not All Have Access

FRIDAY April 11, 2008 -- More than one-third of Americans are now getting hospice care services before they die, but that care still isn't available to many people in the country, a new study finds.

Communities with people with low incomes and education levels, and those with sizeable elderly populations, are less likely to have access to hospice care than areas with wealthier, more educated people, the study said.

"The way most hospices are constructed is using charity. They have to exist before Medicare will pay for their services," said lead researcher Dr. Maria J. Silveira, an assistant professor of internal medicine at the University of Michigan.

This requirement has limited access to hospice care for people in poorer areas, Silveira said. "If Medicare was truly interested in improving access to hospice, what it would need to do is find a way to break the reliance on charity in order to build hospices in the communities that are underserved."

Silveira also thinks Medicare reimbursement is too low for many hospices to make money. While the reimbursement for home hospice care is probably adequate, reimbursement for in-hospice care is too low, she said.

For the study, Silveira and her colleagues used Medicare data, along with county data from the 2000 Census, to create a computer model of hospice care in the United States.

The researchers found the availability of hospice care was high in the Northeast, upper Midwest and in much of California. Hospice care was less available in states along the Mississippi River, in the Rocky Mountain region, and the Southwest. The South, Texas, Florida, and the Plains states had the lowest average availability of hospice care.

The researchers said the availability of hospice care was associated with average income level, education level, and the number of people over 65 living in a particular county. People with incomes of more than $100,000, or people who had at least a high school diploma, had better access to hospice care, the study found.

One surprising finding was that older people had less access to hospice care, said Silveira, who was to present the findings Friday at the Society of General Internal Medicine's annual meeting, in Pittsburgh.

One expert said the study may not be entirely accurate, because it relied on data from 2000, and hospice care has become more available in the last decade, although disparities still exist.

"There has been very significant growth in the hospice benefit use under Medicare since 2000," said Vincent Mor, chairman of the Department of Community Health at Brown University School of Medicine. "Thus, the data are relatively old regarding the distribution of hospices around the country. And the hospice provider of service files that they [the study authors] used tend to be even more out of date, which means that they may have undercounted hospices in existence even in 2000," he added.

"However, the general principles underlying the findings certainly are consistent with my own research in the long-term care arena, Mor said. "Rural and poor communities have worse access to all sorts of medical care."

Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, said charity is playing less of a role in hospice care than it once did.

"There's been a lot of growth in for-profit hospices," he said. "There are organizations that offer hospice care without being dependent on donations."

Schumacher said Medicare reimbursement is about $125 a day for home hospice care and $600 a day for in-hospice care. "Generally, in-hospice care is short-term care," he said. "Typically, it might be for five to seven days."

Schumacher acknowledged that there are geographic differences in the availability of hospice care but that also has improved in the last eight years.

More information

To learn more about hospice care, visit the National Hospice and Palliative Care Organization.

Posted: April 2008


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