The COVID-19 pandemic has focused the spotlight on many disparities in America, with higher rates of infections and deaths among lower-income populations and communities of color. Infection and mortality rate are not the only disparities apparent in America though. There are many differences in end-of-life care that patients receive based on ethnicity, race, social status, and economic status. While efforts to increase equality should focus on mortality prevention, policymakers and clinicians should also seek to eradicate inequities in end-of-life care.
End-of-life care takes on many forms depending on socioeconomic class and race. Medicare and Medicaid are the two biggest corporations in end-of-life care for low-income populations. Hospice and palliative care are frequently unavailable to American Indians and Alaska Natives for a variety of reasons. Poverty and geographic isolation are major factors in indigenous communities’ limited access to end-of-life care services, which mirrors greater inequities among rural patients of all races. Many tribal health institutions are also unable to meet the numerous Medicare and Medicaid standards for hospice treatment, leaving patients to rely on outside hospice programs that are typically oblivious to tribe culture and norms about end-of-life care.
Most alarming, research shows that disparities in access to hospice and palliative care result in negative outcomes for lower-income populations and racial/ethnic minorities with serious advanced illnesses. Another factor contributing to this pattern is that hospice and palliative care has traditionally focused on cancer, whereas other illnesses, such as end-stage kidney disease, which has significantly higher rates among racial minorities, can cause symptoms as severe as cancer, but patients with these illnesses are less likely to receive key elements of high-quality end-of-life care.
What can be done? First and foremost, financial access to health-care services must be enhanced. States should eliminate prescription drug caps that prevent proper end-of-life symptom management, and Congress should designate hospice as an essential service required in state Medicaid systems. A road to affordable coverage for undocumented immigrants is also necessary to ensure that they have access to meaningful health care throughout their lives. Second, unlike Medicare, Medicaid’s long-term care function opens up the possibility of extending access to inpatient hospice, a place that provides superior family-reported end-of-life care than hospitals and nursing homes. Because of its long-term care component, Medicaid might possibly assist hospice usage to a higher extent than other programs, given that lack of proper help at home is a key obstacle for many families contemplating hospice. Third, initiatives to make hospice and palliative care more accessible in underprivileged institutions and communities are crucial. The quick deployment of telemedicine during the COVID-19 epidemic indicates a new approach for sending palliative care professionals to rural locations.