Hospice Care

Addressing Disparities in Hospice and Palliative Care Access for Rural Americans

Americans living in rural areas often lack access to needed medical services, due to both proximity and a lack of financial resources. Hospice and palliative care are no exception. A 2019 study by the Medicare Payment Advisory Commission found that only 18% of American hospices operate in rural areas. While it makes sense that the majority of hospice providers operate in urban and suburban areas, this immense disparity deeply affects the upwards of 46 million Americans who live in rural areas across the country.

According to the Census Bureau, more than one in five older Americans – that is, people aged 65 or older – live in rural areas. With rural communities being disproportionately made up of seniors when compared to their urban and suburban counterparts, It becomes clear that we must close the gap in access to care by addressing the challenges for patients and providers alike. 


Challenges for Hospice Providers

Expanding hospice and palliative care to rural communities isn’t as easy as simply opening new locations in these areas. There are many obstacles that prevent care providers from pursuing rural areas. 

Operations in rural areas most often bring in less revenue than those in more highly populated areas, making it more difficult to cover expenses and attract providers who are making financial decisions. Additionally, it can be difficult to both find a location and staff that location, as employees would either need to live in the area, which is less likely due to health care worker shortages that are plaguing the nation, or be willing to commute, something that would likely require paying workers a higher salary. This could be difficult given rural operations’ lower profit margins. 


Challenges for Rural Communities

Once we get past the physical and financial barriers to entry, another problem arises – getting rural Americans to go to and trust hospice providers. If you have lived without access to something like hospice and palliative care, you may not see the necessity of it. A 2022 study found that among the top barriers to improving palliative care access in rural areas, three of the top issues were related to communication and education gaps. 

If you’re a rural American, you deserve to have access to the same level of care that urban and suburban dwellers have. Push past the discomfort and discuss end-of-life planning and the benefits of hospice and palliative care with your physician. The same 2022 study found that this type of communication between care providers and patients was key to ensuring rural populations take advantage of these care options.  

The study also underscored something the medical community, and particularly hospice providers, have been focusing on in the past few decades; the importance of understanding and valuing the cultural beliefs and preferences of the patients. For patients who have avoided hospice care for fear that their beliefs may be ignored, it’s important to know that the majority of providers place a high value on ensuring every patient is given care that aligns with their morals and faith.

Another factor that impacts rural Americans’ desire to seek out hospice and palliative care services is the cost. If you are from areas with little-to-no access to these care types, you may be unaware that Medicare covers much of the cost of hospice care and, understandably, be hesitant to seek treatment. However, every American is entitled to a certain level of assistance when seeking out these care types, regardless of socioeconomic status.


How Can We Close The Gap?

To ensure rural Americans have the same access to hospice and palliative care as their non-rural counterparts, there needs to be a three-pronged approach: providers need to come to rural areas, doctors need to ensure end-of-life conversations are happening, and patients need to accept the care.

First, hospice providers need to invest in bringing care to these regions. You cannot expect patients and their families to travel potentially hours to receive quality care, and with rural populations using hospice services at a lower rate than populations in the rest of the U.S., it’s clear that they aren’t willing to do that. 

Hospice providers need to meet rural Americans where they are – that is, rural America. The increasingly common implementation of home health care is one way hospice and palliative care providers can bring care to these populations. This allows providers to operate out of a central – potentially more urban – location and send care team members to rural patients without taking on the financial burden of operating and staffing a brick-and-mortar location in the rural areas. 

The home health option also gives providers the opportunity to meet these patients on their level – they are likely a lot more comfortable receiving care in their own home versus a medical facility. 

Second, providers both need to meet rural Americans where they are physically and meet them at their level of knowledge about the care type. Education has to be a priority for providers hoping to operate in rural settings. However, it’s essential that providers don’t take the lack of understanding from their rural patients and their families as ignorance. Providers must operate from an earnest place of compassion and willingness to explain. 

Furthermore, providers need to work with third-party organizations and government agencies to keep costs down for all patients, but especially rural patients. Connecting patients and their families with grants, insurance options and other resources is a great way to ensure rural Americans receive the care they deserve without needing to worry about the financial cost.

And third, the end-of-life journey can be scary and overwhelming, every patient and family facing this deserves the support hospice and palliative care can provide.

At the end of the day, it’s the medical community’s responsibility to ensure that every patient possible receives access to high-quality care, regardless of where they live or their socioeconomic status. 
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