Tips for increasing minority staff, access to care

Outreach in key communities is crucial

Hospice leaders and other experts say that hospices can improve their ratio of minority staff and increase referrals among minority patients by making this a goal and implementing creative outreach programs.

Here are some of their suggestions:

• Attend ethnic festivals and market in ethnic media.

The Hospice of the Bluegrass in Lexington, KY, makes a point of having a presence at the area's annual Roots Heritage Festival, says Gretchen M. Brown, MSW, president and CEO.

"We have Hispanic and African American radio stations and newspapers in our communities, and we attempt to get stories in them," Brown says.

• Employ more minorities.

"At the end of life, people tend to cling to more familiar institutions, customs, and networks, so hospices that have African American nurses, nursing assistants, chaplains, and social workers might be more attractive to African American patients," says Kimberly S. Johnson, MD, an assistant professor of medicine at Duke University School of Medicine in Durham, NC.

• Recruit ethnic and bilingual volunteers.

"We are seeing an increasing number of Hispanic patients, many of whom are taking care of family members who don't speak English," Brown says. "We have some Spanish staff and bilingual employees, but we're also recruiting volunteers who speak Spanish, and we offer Spanish lessons here."

Hospice of the Bluegrass offers staff a six-week, basic Spanish course that is provided in collaboration with the adult education office of the local school district when needed, Brown says. Other hospices might contact their local school district office to inquire about the availability of bilingual teachers and the costs of having them teach on-site, she suggests.

• Train staff to listen to patient's needs and be open to cultural differences.

"When people do end-of-life care well, they offer culturally appropriate communication," Johnson says. "They listen to patients and families when they discuss their own beliefs about care and show that they'll respond to their needs and concerns."

• Provide education to minority staff to improve their careers.

Sometimes the problem is that there aren't enough minority professionals on staff.

This is an opportunity for hospices to recruit minority professionals through providing training and education that will help nonprofessional staff move into a professional position.

Capital Hospice in Falls Church, VA, had a young Latina worker who cleaned the building, says Malene Smith Davis, MBA, MSN, RN, CHPN, president and CEO. "I was talking to her one day and learned she wanted to become a certified nursing assistant [CNA]," she recalls. "I said, 'Why don't you look into schooling?'"

The woman said it costs $1,400 to take the classes she'd need, and she couldn't afford it. At the time, Capital Hospice didn't have education funds to cover that cost, so Davis paid for her coursework out of her own personal funds. The woman earned her CNA certificate and now is a dedicated employee, she reports.

Inspired by this experience, Davis had the hospice start a scholarship fund that pays for staff to improve their professional education. "We need to be looking for employees like her because you never know who is in your midst," she says.

• Market hospice on a broader scale.

The National Hospice & Palliative Care Organization (NHPCO) of Alexandria, VA, started a program, which now is a separate organization Foundation for Hospices in sub-Saharan Africa (FHSSA), in which hospices can partner with hospices in sub-Saharan Africa, Brown says.

"So we have a partner hospice in South Africa, and we hold fundraisers for it," Brown says. "Our plan is to use this partnership to [garner] some interest in the greater community."

• Educate staff to change attitudes about different cultures.

Sometimes an obstacle to improving hospice access to minorities is a misperception among hospice staff. For example, Brown has sometimes heard hospice staff say that a particular culture doesn't need hospice care because they're more family-oriented and take care of their own. "Generalities about ethnic groups are always dangerous," she says.

One way to overcome this barrier is to provide hospice staff with education and teaching sheets about diversity and dealing with different cultures, Brown says. NHPCO provides some diversity and cultural information, she says. Some hospitals also have such material available.

• Provide a community bereavement program.

Bereavement programs are an excellent way to provide outreach to the entire community, including minority groups, Brown suggests.

Hospice of the Bluegrass started a bereavement program that has blossomed into a partnership with various groups in the community, and it's provides a good example of the kind of help hospice offers, she says. "In many cities, you have young men dying of violence and drug abuse problems," she says. "We wanted a community bereavement program for people impacted by these issues."

Need More Information?

For more information on minority staff and referrals among minority patients, contact:

  • Foundation for Hospices in sub-Saharan Africa, 1700 Diagonal Road, Suite 630, Alexandria, Virginia 22314. Telephone: (703) 647-5176. E-mail:
  • National Hospice and Palliative Care Organization (NHPCO), 1700 Diagonal Road, Suite 625, Alexandria, VA 22314. Telephone: (703) 837-1500. Web: Also, specific and free information about different cultures and diversity can be found at NHPCO's Caring Connections web site:
  • NHPCO's "Inclusion and Access Toolbox" is a collection of suggestions and successes based on the thoughts and experiences of hospice providers in many settings throughout the United States. It highlights populations with diverse economic, education, sexual preference, and physical and other abilities. It's available for sale on the NHPCO web site ( under "Catalogs") for $24.99 for NHPCO members and $39.99 for nonmembers.