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Palliative Care Services Vary by U.S. Region, Population

Black and Hispanic nursing home (NH) residents are more likely than their white counterparts to be living in facilities that provide fewer palliative care services, a new study from Columbia University School of Nursing shows. 

“This research highlights the importance of improving end-of-life care for the increasingly diverse nursing home population,” says Patricia Stone, PhD, the senior author of the study and a professor and director of the Center for Health Policy at Columbia Nursing. 

“This study builds upon our understanding of racial disparities in nursing homes by looking at palliative care services, which are essential at the end of life,” says Leah Estrada, a PhD candidate at the nursing school and the study’s first author. “Nursing homes with higher concentrations of Black and Hispanic residents are disadvantaged and targeted policy efforts are needed to improve services based on populations served.” 

Palliative care is intended to relieve symptoms in seriously ill patients, regardless of their prognosis, Stone, Estrada and their colleagues note in their report in the Journal of Palliative Medicine. In nursing homes, palliative care involves continuing care planning to ensure that a resident’s goals of care are met and their dignity is considered, especially approaching the end of life, they add. 

NH patients overall are known to face racial and ethnic disparities in care, the authors write. Black and Hispanic NH residents are sicker, and they are more likely to live in segregated, financially strained NHs that depend heavily on Medicaid. They are also more likely to undergo aggressive treatment and hospitalization, less likely to get hospice care at the end of life, and receive worse pain management. 

To investigate whether nursing home palliative care varies by region and concentration of Black and Hispanic residents, the researchers surveyed 869 nursing homes across the U.S., selected to represent all of the nation’s roughly 15,000 nursing homes.  

Overall, facilities provided less than half of palliative care services assessed by the survey. NHs in the Northeast provided the most palliative care, while those in the South provided the least.  

In the Northeast and West, the authors found, the NHs with a higher proportion of Black residents provided less palliative care. In all regions, palliative care services decreased as the percentage of Hispanic residents increased. 

To address the issue, Stone, Estrada and their colleagues note, the Center for Medicare and Medicaid Services could develop payment incentives focused on advancing health equity. 

“Given that NH care is suboptimal, particularly at the end of life, palliative care may be the missing link to improve quality of care for Black and Hispanic residents,” they conclude.