National hospice study reveals gaps ...( Fewer services seen in areas with ol...),Health

Fewer services seen in areas with older, poorer, less educated populations likely due to low Medicare funding and reliance on charity for end-of-life care

ANN ARBOR, Mich. More than a third of Americans now die under the care of a hospice service, a huge increase from just a decade ago and a major advance in end-of-life care.

But a new University of Michigan study reveals major gaps in the availability of hospice care across the country gaps that the researchers attribute directly to the way hospice care is currently funded in America.

Most strikingly, the study finds that communities with lower average incomes and education levels, and areas with large concentrations of elderly people, are far less likely to be served by a hospice than communities with wealthier, more educated and younger populations.

In an oral presentation Friday at the Society for General Internal Medicine meeting, U-M Medical School and VA researcher Maria Silveira, M.D., M.P.H., shared findings from an analysis that combined national Medicare data on hospices and federal county-level 2000 Census data in a sophisticated computer model.

The resulting map of the United States looks like a blotchy patchwork, with very high hospice availability in the Northeast, upper Midwest and much of California, lesser availability in states along the Mississippi and in the Rocky Mountain states and desert Southwest, and much lower-than-average availability across much of the South, Texas, Florida and the Plains states. There was wide variation within regions.

On average, the study found, counties have 2.1 hospices located within their borders, but the number ranges from none to 125. When the researchers looked at 60-mile-radius service areas the range recommended by the National Hospice and Palliative Care Organization the average number of hospices serving a county was just over 52. But it ranged widely from none to 280.

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