Hispanic influence grows, but not in hospice care

FL hospice offers special outreach

It has been said that your chances of dying in pain in America are greater if you do not speak English or if you are African-American, Hispanic, poor, elderly, or a woman. Much has been made lately of how hospice can better serve those who aren’t white, middle-class males.

The Boca Raton, FL-based Hospice By The Sea has seen the local population of Hispanics grow over the past few years. Hispanics make up 15% of the total population in the hospice’s service area, but less than 2% of its patients. In an effort to turn those statistics around, the hospice recently accepted more than $1 million to implement a program aimed at boosting Hispanic participation in hospice.

Program organizers hope the effort will shed some light on how to increase hospice participation among Hispanics, and perhaps offer a national model for doing so.

The money comes from grants, half of it from the Robert Wood Johnson Foundation, to support the hospice’s program called "Abriendo Puertas" (Opening Doors), which will serve Hispanics in Palm Beach and Broward Counties. It involves the use of teams of bilingual professionals knowledgeable of and sensitive to Hispanic customs and traditions.

Hospice staff rooted in community

The hospice’s effort to boost Hispanic participation includes community education and a culturally sensitive approach to care. For example, many Hispanics, with their strong family ties, take on care of the dying on their own and shun outside help. By using staff that are rooted in the community, the hospice hopes to gain caregivers’ trust and acceptance, says Cindy Hassett, MPA, project director of Abriendo Puertas. "Most Hispanics don’t know what hospice is," Hassett says "They think it is a place where you go to die, or they don’t buy into it because it isn’t culturally sensitive."

Hispanic families who choose to care for their loved ones in their own homes will be served by hospice using three approaches to improve understanding and access to hospice services:

  • an educational outreach emphasizing hospice as a program, not just a place, designed to support, not replace, the family’s ability to provide end-of-life care;
  • customized services, including the creation of a special, culturally responsive, bilingual interdisciplinary patient care team for Hispanic hospice patients;
  • a cultural competency learning program to enhance the cultural sensitivity of all Hospice By The Sea staff and other community health care providers, including hospitals, nursing homes, and physician offices.

Historically, Hispanics, like a number of other ethnic groups, have shied away from hospice. But the growth of the Hispanic population across the country suggests that hospices must do more to reach a significant chunk of that population.

As in many other areas, Hispanics are among the fastest-growing ethnic groups in South Florida. According to the U.S. Census Bureau, among the more than 1 million people living in Palm Beach County today, more than 130,000 are Hispanic, 13,000 are Haitian, and 174,000 are African-American. Minorities already make up half of Palm Beach’s public school students, with one out of every eight students speaking English as a second language.

By the year 2025, Hispanics are expected to become the largest ethnic group in Palm Beach County, and Florida will be home to the nation’s third-largest Hispanic population. Florida already has the highest Hispanic population in terms of growth.

Yet Hispanic use of hospice has failed to keep pace with the group’s rapid population growth. Experts say a number of factors contribute to hospice’s dismal penetration of the Hispanic market. Hospice By the Sea and other hospices located in communities with a large Hispanic population face a number of challenges as they try to address low usage among Hispanics.

Hospice By the Sea’s solution

Hospice By the Sea officials are well aware of the challenges that confront them. Their program is designed to address both the larger issue of misunderstanding about hospice care in the Hispanic community and the need for culturally sensitive care of those who are enrolled in hospice.

To address the language challenge, the members of the interdisciplinary team caring for Hispanic patients are bilingual and are rooted in the community. Not only does this provide outward evidence that the hospice has the community’s interests at heart, it gives the team a foothold in patients’ cultural and religious beliefs, because workers can readily identify with their viewpoints and concerns. In addition, all patient education materials — written and audiovisual — are produced in both English and Spanish.

"With Abriendo Puertas,’ we have customized our end-of-life services, making them more responsive to the culture and traditions of Hispanic families who choose to care for their loved ones in their own homes," says Hassett.

Perhaps a tougher challenge will be in the outreach arena, the daily chipping away at misinformation and building the belief that hospice care is actually in line with Hispanic culture. To do this, the hospice is committed to logging 740 individual encounters per month in which they explain hospice to the members of the Hispanic community.

Hospice officials realized the importance, however, of having allies in the Hispanic community, rather than riding into their neighborhoods as outsiders preaching what is good for them. To that end, the hospice partnered with two Hispanic community groups who have each assigned a staff person to educate the community about hospice.

Each encounter, whether done in groups or individually, begins with a pre-test to establish a hospice knowledge baseline. The person is then shown a video, listens to presentations, asks questions, and then takes a post-test to gauge increased knowledge and changes in attitude toward hospice.

Hassett is hopeful the three-year project will yield a model not only for addressing Hispanics, but other ethnic groups, as well. "Hopefully we will increase the level of knowledge and show that hospice care in congruous with other cultures," Hassett says.