Hospice Facility Utilization Differential Between White Hospice Patients and Minority Hospice Patients

One in five hospice agencies currently operate hospice facilities (HFs). Previous studies indicate that the satisfaction level among families of HF residents is higher than in other settings. While half of hospice patients initially stay at their private residences for hospice care, severely ill patients are transferred to HFs. Using data from the 2007 National Home and Hospice Care Survey (NHHCS), we compared the transfer rate to different settings between non-Hispanic whites and minorities. After conducting a logistic regression tailored to NHHCS's complicated sampling design, we found no significant difference in the transfer rate to hospitals regardless of the different settings between minorities and whites (19.5%; 95% CI, 13.2%-38.6%, vs 16.0%; 95% CI, 13.7%-18.3%). However, for the subpopulation of those transferred from home only, minorities were more likely than whites to be transferred to hospitals (49.5%; 95% CI, 28.0%-71.0%, vs 20.2%; 95% CI, 14.6%-25.8%). This difference remained significant even after adjustment for age, sex, primary payment source, having had a primary caregiver, death at discharge, diagnosis, length of stay, having had emergent care during hospice care, and metropolitan statistical area (0.15 adjusted Odds Ratio of minorities vs whites; 95% CI, 0.05-0.43). This difference was largely due to a higher rate of transfer to HFs among whites and suggests that there may be racial disparities in HF utilization. Whether geographical locations of HFs favoring white-dominant areas, financial burdens imposed on HF residents, such as out-of-pocket payment for room and board, or any other factors contribute to differential HF utilization is unclear.