Special Report: Improving Diversity in Hospice Care

Extensive program for increasing minority access to care

Outreach committees are key to program

[Editor's note: In this issue of Hospice Management Advisor, there is the second part of a two part series about how hospices lack diversity in their staff and patients and what can be done about it. The February, 2006, issue contains a cover story about how hospices still lack diversity in patients and staff. In this issue, there are articles about how the Hospice of Western Reserve in Cleveland, OH, has improved access and diversity and how hospices can do more to connect with minority communities.]

Based in Cleveland, OH, Hospice of Western Reserve has long recognized the need for its hospice program to represent its community's diversity in staff and patients.

In 1992, the hospice formed a staff diversity committee that worked with consultants and devised a mission statement and objectives, says Shareefah Sabur, MNO, director of planning and evaluation.

"One of our objectives was to review policies and procedures to make sure they were not biased," Sabur says. "We also came up with educational activities."

In the last five years, the hospice's minority admissions have fluctuated in the 20 percent range, while nationally, minority admissions are less than 14 percent, Sabur says.

The hospice serves a five-county area that includes Cleveland, which has a majority minority population, Sabur says.

The adjacent counties are predominantly white, so the overall percentage of minority admissions reflects the hospice's service area, she notes.

However, the diversity program encompasses much more than race, Sabur says.

"We look at religious diversity, and we've made initiatives for the Jewish population," Sabur says.

Also, the Cleveland area has seen a major shift in culture as more individuals have moved to the region from Vietnam, Russia, Croatia, and the Mideast, says Bridget Montana, MS, APRN, MBA, chief operating officer.

"We look at how we can impact our practice and create programs to serve different populations," Montana says. "From a human resource perspective, we are hiring staff that represents different diverse populations."

Two areas within the hospice's reach are densely populated with Hispanic families, including people from Mexico and Puerto Rico, Montana notes.

"One organization we work with trains Hispanic individuals as nursing assistants with plans to be trained as nurses," Montana says. "We've hired several nursing assistants and work with them as they work toward their nursing degrees."

All of these nursing assistants are bilingual and work and live in the hospice's western service area, she adds.

The hospice also has incorporated cultural sensitivity into its orientation and staff education, Montana says.

In the last few years, the hospice has used an interpretation service that has interpreters representing 150 languages. These interpreters can be on the telephone with the family and patients while hospice workers are in the home, Montana adds.

"We keep a database with volunteer and staff information about the different languages they speak," Sabur says.

Hospice managers also have met with an African American nursing association and the Greater Cleveland Nursing Association to promote hospice work.

"A lot of people are interested in hospice work through word-by-mouth," Sabur says. "The more minority staff we hire the more we can attract because you have someone who can advocate the organization within those pockets of people."

Another strategy the hospice has employed involves the formation of an African American Outreach Committee, whose job is to get more information about hospice into the African American community.

"Our goal was to change and address some of the myths in the community," says Valerie Ridgeway, BA, community relations and public policy coordinator with Hospice of Western Reserve.

The outreach committee was formed 3.5 years ago, Ridgeway says.

The committee identified the people who are trusted most within the community, including those in the faith community, physicians, and others and asked them to serve in an advisory capacity, Ridgeway explains.

The committee has 20 people, including representatives from long-term care facilities, a media person, and representatives from various churches, a funeral home, medical facilities, other health care agencies, and the city of Cleveland, she says.

"The idea is for the members to give us inroads into their sphere or domain of influence," Ridgeway says. "So if we have someone who is in the congregation of a large church, we expect them to help us get on the church's agenda."

For example, the hospice was able to speak during a Sunday morning service at one area church because of a committee representative, Ridgeway notes.

Each committee meeting has an educational component with a speaker, and topics have included palliative care, with detailed descriptions of pain management and a discussion of hospice myths, Ridgeway says.

For instance, one myth was that people have to leave their homes to receive hospice care, because people often think of the hospice's residential house, Ridgeway notes.

"I often get an 'Oh-ow,' when I say our residential facility takes care of 42 people a day, but we have 1,000 patients in the community," Ridgeway says.

"I encourage the committee to take on the role of ambassador and go back to their different organizations and present the same information they've learned," she says.

The committee's other work has included distributing hospice fliers to African American church congregations and looking for African American volunteers.

"There's a whole movement of getting information out through the barber shops and hair dressing salons, where people go to talk, and hopefully we can do that this year," Ridgeway says.

"One other thing we do is email the committee a listing of staff openings so they can in turn share these with their organization or group," Ridgeway adds.

A remaining challenge is for the hospice to become more fully integrated in multicultural communities, Montana says.

"We're better educated and have staff on board who have helped with the different communities, but it doesn't always work to go in with education and communication and tell people what to do," Montana says. "There's a sense in the community that you need to be a part of them and know their churches and schools and who they are as a community."

This philosophy goes back to Hospice of Western Reserve's roots, Montana says.

"We started by creating satellite offices that put us in the community," she says. "It helped us go to the next level."

The key to expansion in multicultural communities is similar.

"You start with someone in that community and connect with them and build a relationship and then work from that relationship," Sabur says. "We continue to push forward because we know there still are other groups we have not been able to reach yet."

Diversity work never ends, Sabur notes.

"Even as we reach more people we still are challenged to keep our staff very sensitive, so that's ongoing training, as well," Sabur says.

Need More Information?

  • Bridget Montana, MS, APRN, MBA, Chief Operating Officer, Hospice of Western Reserve, 10645 Euclid Ave., Cleveland, OH 44106. Web site: www.hospicewr.org.
  • Valerie Ridgeway, BA, Community Relations and Public Policy Coordinator, Hospice of Western Reserve, 10645 Euclid Ave., Cleveland, OH 44106. Web site: www.hospicewr.org. Email: vridgeway@hospicewr.org.
  • Shareefah Sabur, MNO, Director of Planning and Evaluation, Hospice of Western Reserve, 10645 Euclid Ave., Cleveland, OH 44106. Web site: www.hospicewr.org. Email: ssabur@hospicewr.org