Few Minorities Use Hospice Care In California, Study Says

Mary Engel, Los Angeles Times, March 16, 2007

Far fewer Asian Americans, African Americans and Latinos than whites use hospice care for terminal illnesses, according to a study released Thursday on how end-of-life care in California differs by race and ethnicity.

And a disproportionate number of African Americans, Latinos and Native Americans die suddenly and unexpectedly of accidents or assaults, often in hospital emergency rooms that lack family support programs or bereavement counseling.

Still, most deaths across all races and ethnicities are caused by chronic diseases such as heart disease or cancer, according to Dr. Mark D. Smith, president and chief executive of the Healthcare Foundation, an Oakland-based philanthropy that commissioned the study.

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The report, co-written by Dr. LaVera Crawley, a Stanford University medical ethics researcher, and Marjorie Kagawa Singer, a professor at the UCLA School of Public Health and the Asian American Studies Center, analyzed 2004 death records from the California Department of Health Services, among other sources.

Whites made up 74% of hospice deaths; Latinos, 15%; African Americans, 6%; and Asian Americans, 4%.

A higher rate of accidental deaths and lower rates of health insurance don’t fully explain the huge difference among racial and ethnic groups in hospice use. Nor do language barriers that limit information and complicate access to hospice services.

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“The hospice movement comes out of a rejection of some of the modernity of medicine,” Smith said. “People who have been fighting for access to that healthcare system are likely to be suspicious that we’re just looking for a reason to not give them all these goodies they’ve been trying to get.”

Other cultural and individual preferences influence the decision to give up high-tech interventions and potentially life-saving technologies. Giving up such high-tech care is a requirement of Medicare if it is to pay for hospice services. Talking about death is uncomfortable to many and is taboo in some cultures. According to a study cited in the report, elderly Mexican Americans and Korean Americans in Los Angeles did not like the idea of advance directives, written instructions about treatment preferences in case of a coma or other inability to communicate. They believed that to put something in writing hastened death.

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[Editor’s Note: Racial, Cultural, and Ethnic Factors Affecting the Quality of End-of-Life Care in California can be read here.

It can be downloaded, along with other documents, including a supplemental, here.]


Abstract: Racial, Cultural, and Ethnic Factors Affecting the Quality of End-of-Life Care in California

LaVera Crawley, M.D., M.P.H, and Marjorie Kagawa Singer, Ph.D., R.N., M.N., California HealthCare Foundation, March 2007

The most ethnically diverse state in the nation, California has an opportunity to set a national example for quality end-of-life care for all its residents. Providing quality care requires knowledge of the population served and its needs and preferences.

This report reviews and analyzes current data, along with new research from focus groups and surveys. The report examines the causes and patterns of death and dying across California’s populations and the impact on the delivery of health care.

Hospice care is generally considered the “gold standard” for end-of-life care in California and across the country. However, the report finds there is wide variation in preferences for care among various racial and ethnic populations. In addition, there are significant limitations on the availability and appropriateness of hospice for some patients:

* Requirements for hospice enrollment can conflict with the preferences of patients; in particular, African Americans and Latinos may not want to forego acute therapies not covered by Medicare’s hospice benefit, the report concluded. Medicare and most private insurance companies require a life-expectancy prognosis of six months or less to be eligible for hospice services and do not cover care that combines both hospice (pain management and supportive services) and such curative or life-prolonging services as chemotherapy or dialysis.

* Ethnically diverse populations are significantly less likely to use hospice care than whites. In 2004, for example, of those who died while receiving hospice services, only 4% were Asian American, 6% were African American, and 15% were Latino, contrasted with 74% who were white.

* Sudden deaths due to accidents and assaults are comparatively higher among young Latinos (16%), African Americans (11%), and Native Americans (14%) than among whites (7%) and Asian Americans (8%). However, the report found that some end-of-life services, such as family support programs and bereavement counseling, are lacking in most emergency departments.

 

Press Release: Californians’ End-of-Life Care Differs by Race and Ethnicity

LaVera Crawley, M.D., M.P.H, and Marjorie Kagawa Singer, Ph.D., R.N., M.N., California HealthCare Foundation, March 2007

The most ethnically diverse state in the nation, California has an opportunity to set a national example for quality end-of-life care for all its residents. Providing quality care requires knowledge of the population served and its needs and preferences.

This report reviews and analyzes current data, along with new research from focus groups and surveys. The report examines the causes and patterns of death and dying across California’s populations and the impact on the delivery of health care.

Hospice care is generally considered the “gold standard” for end-of-life care in California and across the country. However, the report finds there is wide variation in preferences for care among various racial and ethnic populations. In addition, there are significant limitations on the availability and appropriateness of hospice for some patients:

* Requirements for hospice enrollment can conflict with the preferences of patients; in particular, African Americans and Latinos may not want to forego acute therapies not covered by Medicare’s hospice benefit, the report concluded. Medicare and most private insurance companies require a life-expectancy prognosis of six months or less to be eligible for hospice services and do not cover care that combines both hospice (pain management and supportive services) and such curative or life-prolonging services as chemotherapy or dialysis.

* Ethnically diverse populations are significantly less likely to use hospice care than whites. In 2004, for example, of those who died while receiving hospice services, only 4% were Asian American, 6% were African American, and 15% were Latino, contrasted with 74% who were white.

* Sudden deaths due to accidents and assaults are comparatively higher among young Latinos (16%), African Americans (11%), and Native Americans (14%) than among whites (7%) and Asian Americans (8%). However, the report found that some end-of-life services, such as family support programs and bereavement counseling, are lacking in most emergency departments.

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