Hospice Access for Undocumented Immigrants

Abstract

Discussion | In this study, nearly one-third of hospices did not enroll undocumented immigrants or limited the number enrolled, and 23% of referrals were not accepted. Restricted enrollment was more common among for-profit and smaller hospices, which is not surprising given the financial challenges of enrolling patients without a funding source. Hospice reduces health care costs and improves end-of-life care quality. 5 Undocumented immigrants unable to access hospice may be forced to seek treatment for symptoms and psychosocial needs through emergency services or hospitalization, which may increase costs for health systems and compromise end-of-life care.This study has several limitations. Of the 230 agencies responding to the full survey, 51 (22.2%) did not complete the survey questions pertaining to undocumented immigrants, and only 15 (8.4%) agencies responding to these questions came from the US West census region, where many undocumented immigrants reside and demand is likely high. Also, the proportion of for-profit hospices was low relative to their representation nationwide. These factors may limit generalizability and lead to overestimation of access.Our data demonstrate existing demand for hospice for undocumented patients, and suggest hospice access may be disproportionately limited in areas with predominately smaller, for-profit agencies. As the proportion of for-profit hospice agencies continues to grow nationally, barriers to hospice access for undocumented patients may increase. While some cities and states are expanding health care for undocumented immigrants, 6 for many, health care access remains limited. Based on this study, such limitations persist through endstage illness. Policies that reduce barriers to hospice for this population may improve end-of-life care and reduce costs.

End-of-Life Care for Unauthorized Immigrants in the U.S.

“…24 As many more unauthorized immigrants are becoming long-term U.S. inhabitants, some researchers have predicted that the demand for hospice services in this population is likely to increase over time. 20 A recent report by Gray et al 20 found that 32% of U.S. hospice agencies limited or did not enroll unauthorized immigrants as patients. Some hospice agencies currently provide charity care for uninsured unauthorized immigrants without the financial ability to pay; however, most restrict the number of pro bono patients they will serve.…”

“…The limited number of studies to date suggests that unauthorized immigrant enrollment is more feasible for larger, nonprofit, independent hospice agencies. 19,20 Home hospice agencies typically require that patients have an appropriate place to live and a fulltime primary caregiver. However, owing to their overall poor socioeconomic status, many unauthorized immigrants have neither.…”

Challenges for Adult Undocumented Immigrants in Accessing Primary Care: A Qualitative Study of Health Care Workers in Los Angeles County

“…2,3,7 Lack of coverage has led to harmful delays in care, increased acute care utilization, and poor health outcomes. [4][5][6][8][9][10][11][12][13][14][15][16][17] In addition, recent changes and even proposed changes to immigration policies and practices have engendered fear within immigrant communities, resulting in further negative health and social impacts. [18][19][20][21][22][23][24] These policies, in addition to other challenges (e.g., language, discrimination, and stigma), result in a formidable health care environment for undocumented immigrants.…”

Caring for Undocumented Immigrants With Kidney Disease

“…Emergency Medicaid funding does not cover outpatient end-of-life services for undocumented patients, and for-profit hospice facilities are reluctant to accept unfunded patients. 33 Hence, patients seek treatment for symptoms and psychosocial needs through emergency services or hospitalization. Latino patients treated by dialysis are less likely to have an advanced directive or die receiving hospice services.…”