While Hospice Care Is Growing, Not All Have Access

Wealthier, better-educated communities have more facilities offering the end-of-life care, study finds

By Steven Reinberg
HealthDay Reporter

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FRIDAY, April 11 (HealthDay News) -- 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.

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"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.

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