One surprising finding was that older people had less access to hospice care, said Silveira, who was to present the findings Friday at the Society of General Internal Medicine's annual meeting, in Pittsburgh.
One expert said the study may not be entirely accurate, because it relied on data from 2000, and hospice care has become more available in the last decade, although disparities still exist.
"There has been very significant growth in the hospice benefit use under Medicare since 2000," said Vincent Mor, chairman of the Department of Community Health at Brown University School of Medicine. "Thus, the data are relatively old regarding the distribution of hospices around the country. And the hospice provider of service files that they [the study authors] used tend to be even more out of date, which means that they may have undercounted hospices in existence even in 2000," he added.
"However, the general principles underlying the findings certainly are consistent with my own research in the long-term care arena, Mor said. "Rural and poor communities have worse access to all sorts of medical care."
Donald Schumacher, president and chief executive officer of the National Hospice and Palliative Care Organization, said charity is playing less of a role in hospice care than it once did.
"There's been a lot of growth in for-profit hospices," he said. "There are organizations that offer hospice care without being dependent on donations."
Schumacher said Medicare reimbursement is about $125 a day for home hospice care and $600 a day for in-hospice care. "Generally, in-hospice care is short-term care," he said. "Typically, it might be for five to seven days."
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