Nathan A Gray1, Nathan A Boucher2,3,4,5, Lilia Cervantes6,7,8, Nancy Berlinger9, Sophia K Smith10, Kimberly S Johnson2,5,11. 1. Duke Palliative Care, Division of General Internal Medicine, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. 2. Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA. 3. Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System Health Services Research and Development, Durham, North Carolina, USA. 4. Duke University Sanford School of Public Policy, Durham, North Carolina, USA. 5. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina, USA. 6. Division of Hospital Medicine and Office of Research, Denver Health, Denver, Colorado, USA. 7. Division of Hospital Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA. 8. Division of General Internal Medicine, Department of Medicine, University of Colorado, Anschutz Medical Campus, Denver, Colorado, USA. 9. The Hastings Center, Garrison, New York, USA. 10. Duke University School of Nursing, Duke University, Durham, North Carolina, USA. 11. Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina, USA.
Abstract
Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Setting/Subjects: Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Measurements: Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chi-square analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. Results: A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; p = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Conclusions: Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.
Objectives: To characterize clinician experiences of hospice access and scope of services for undocumented immigrants. Background: The 10.5 million undocumented immigrants in the United States are not covered by Medicare's hospice benefit and are at high risk for being uninsured. Limited data are available regarding hospice services for this population. Setting/Subjects: Two hundred ninety-four interdisciplinary palliative care clinicians from across the United States. Measurements: Participants completed a web-based survey regarding hospice access and scope of services for undocumented immigrants in their location. We used simple frequencies to report clinician responses and chi-square analysis to evaluate associations between response and location. We performed rapid qualitative analysis of free-text responses to identify common limitations in scope of services. Results: A majority of clinicians (68%) perceived that access to hospice was limited or unavailable for undocumented immigrants in their location, and among respondents who provided data regarding hospice scope, 38% reported that services provided to undocumented immigrants were limited compared to those provided to other patients. Reports of restricted access and scope varied by region, and those in large metropolitan areas were more likely to report restricted scope of care than those in smaller towns (43% vs. 28%; p = 0.03). In our qualitative analysis of free-text responses, common limitations in hospice scope included reduced access to medications and equipment, inability to access inpatient hospice, inadequate translation services, reduced staffing, and restricted duration of services. Conclusions: Undocumented immigrants may face barriers in accessing comprehensive hospice services. Public policy changes that improve access to hospice may improve end-of-life care for undocumented immigrants.
Entities:
Keywords:
health care access; health disparities; hospice; immigration; undocumented immigrants
Authors: Lilia Cervantes; Delphine Tuot; Rajeev Raghavan; Stuart Linas; Jeff Zoucha; Lena Sweeney; Chandan Vangala; Madelyne Hull; Mario Camacho; Angela Keniston; Charles E McCulloch; Vanessa Grubbs; Jessica Kendrick; Neil R Powe Journal: JAMA Intern Med Date: 2018-02-01 Impact factor: 21.873
Authors: Alexander N Ortega; Hai Fang; Victor H Perez; John A Rizzo; Olivia Carter-Pokras; Steven P Wallace; Lillian Gelberg Journal: Arch Intern Med Date: 2007-11-26