La Caja de Pandora: Improving Access to Hospice Care Among Hispanic and African American Patients

Many patients clinging to hope in the form of potentially curative treatment could benefit from hospice services, but, for the most part, it is not until the patient accepts the finality of his or her condition that the physical, psychological and social benefits of hospice care become accessible to the patient and his or her family. Under current Medicare regulations and other health care payers’ policies, patients must abandon the hope of curative treatment before opting for hospice services. As a result, many terminally ill patients access the services late, sometimes a few hours before death. Scholars have proposed that such a barrier to access, present in Medicare, Medicaid and other health insurers’ coverage rules, may be responsible for lower utilization of hospice services and later access to hospice services than has been proven to be beneficial to patients and their families. This problem becomes even more significant, and other barriers beside coverage rules become apparent, when considering the health care needs of racial and ethnic minorities in the United States. Not only do patients in racial and ethnic minority groups access hospice late, like the general population, but they also access it in far fewer numbers. The statistics are especially stark among African-American and Hispanic patients.

This Article explores these powerful statistics, seeking to shed light on the end-of-life decision-making process for Hispanics and African-Americans, with an eye toward identifying barriers to access and utilization of hospice services among those populations.