Hospice and Palliative Care Access Issues in Rural Areas

Abstract

All individuals deserve to have access to quality end-of-life care. In rural communities within the United States, significant barriers limit access to hospice and palliative care. They include issues related to geography and supply, health care system eligibility criteria, limitations of the available workforce, educational deficits, and differences in cultural values. This article examines the barriers and potential solutions to address the gaps in hospice and palliative care services in rural communities. Strategies are proposed to strengthen hospice and palliative care delivery models to enhance earlier referrals and provide better facilitation and transition to hospice and palliative care. Future research should look at patient utilization questions specific to rural communities.

Exploring Barriers Among Primary Care Providers in Referring Patients to Hospice

“…10 Improving attitudes, increasing knowledge, and reducing barriers to hospice referral in primary care would increase access to hospice. 19 The results of this project suggest that providers are comfortable with and have positive attitudes toward hospice, yet referrals are not being initiated. One way to immediately assess patients' candidacy for hospice is the ''surprise'' question: ''Would you be surprised if the patient died in the next 6 months?''…”

Palliative Care in Critical Rural Settings

“…In Table Palliative addition, rural areas have prominent barriers that may limit access to health care, including long distances, unpredictable weather, lack of public transportation, limited health care resources, shortages in the number of health care providers, few certified specialists, and limited opportunities for training in palliative care. 17 Providing palliative care services can be especially challenging in rural settings because of personal and professional role strain, including lack of anonymity and role diffusion, 18 which is common among health care providers in rural environments. 19 …”

Quality of Hospice Care

“…A multitude of factors can explain the discrepancy between needed and received hospice care in rural communities including less hospice provider access, challenges delivering hospice care, characteristics of the rural populations, and beliefs about hospice care and the quality of such care. 3–9 …”

“…3 In 2008, 98% of US residents lived within 60 minutes driving time to at least one hospice. 10 However, for states with a high proportion of rural residents, for example North Dakota and South Dakota, more than 10% of their population lived further than 60 minutes driving time from a hospice.…”