Improving the Use of Hospice Services among Minority Elders

Minority elders underutilize hospice services: 26% of non-Hispanic white Medicare decedents in 2003 had been under hospice care, compared to 21% of Hispanic decedents, 18% of African Americans, and 14% of Asians. This racial difference is more noticeable when the elders reside and die in nursing homes or assisted living facilities than when they die in their private residences. Previous studies have also found that minorities are less likely than white elders to be referred to hospice by physicians. To increase hospice utilization among minority residents in nursing homes and assisted living facilities, we implement a simple communication intervention that a previous study found to be efficient. We plan to conduct a structured interview of 120 residents and/or their surrogate decision makers to identify residents whose goals for care, treatment preferences, and palliative care needs make them appropriate for hospice care. These residents' physicians will be notified and be asked to authorize a hospice informational visit. The outcome measures include (1) hospice enrollment within 30 days of the intervention and (2) families' ratings of the quality of care for residents who die during the 6-month follow-up period. The referral rates among minority elderly will be compared before and after the intervention.