Variation in Hospice Non-Core Services in Rural and Urban Communities (SCI920)

Objectives 1. Discuss variations in hospice service offerings. 2. Construct similar studies with data from the region in which they practice. 3. Appraise and evaluate the components that comprise well-rounded hospice care. Background Medicare Hospice Conditions of Participation requires the provision of both core and non-core services to standardize hospice delivery. Variation in access to and quality of hospice services may be due to revenue and resources. This study explores any possible variations in hospice non-core services across geographic factors. Research Objectives 1. To identify potential incongruities in hospice non-core services in the State of California. 2. To distinguish disparities in addressing hospice care needs in rural versus urban communities. Methods A retrospective analysis of the 2017 California Health and Human Services Home Health Agencies and Hospice Annual Utilization Report was conducted. Data on non-core services, defined as volunteer hours delivered and number of non-core visits from physical therapy, occupational therapy, homemaker services, and hospice aides, were extracted and correlated to hospice size (using revenue as a proxy) and hospice geographic service area (either primarily rural or urban). Results Five hundred forty-one hospices (4% primarily rural) were included in the analysis. Average total operating revenue was $1.6 million for rural hospices and $18.4 million for urban hospices. Rural hospices reported on average 15 non-core visits and 13 volunteer hours per patient compared to 19 non-core visits and 9 volunteer hours per patient for urban hospices. Conclusion No statistically significant correlation was found between hospice size or geographic region and volunteer hours or non-core visits. As rural hospices operate on smaller budgets and census sizes, they may compensate for fewer visits from non-core services with increased volunteer hours by relying more heavily on community philanthropy. Nevertheless, Bereaved Family Surveys continue to reflect overall high satisfaction with hospice services, even across a geographically diverse state such as California. Implications for Research, Policy, or Practice Future research and policy addressing disparities in hospice care may explore how rural hospices continue to provide high quality end-of-life care despite challenges with geographic isolation and limited budgets.