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Residents of Rural Counties May Have Limited Access to Hospice Services

  • Hospice use has increased significantly in the U.S. since 1992, and in-home hospice services for a person with a life-limiting illness can help improve symptom management and ease family caregiving and financial burdens.
  • To be eligible for the Medicare Hospice Benefit (MHB), which can help cover expenses for medications, equipment and supplies, and nursing care, a physician must certify that the person has a life expectancy of six months or less.
  • Researchers examined the health resource availability and community characteristics of over 3,000 counties throughout the U.S., which were classified as either: a) metro (urban), b) adjacent to metro (suburban), or c) non-metro (rural).
  • The number of physicians per 10,000 census was significantly higher in the urban (19), compared to the suburban (9) and the rural (9.5), counties. In addition, a higher percentage of urban counties had at least one hospice (59%), compared to the suburban (39%) and rural (36%) counties.
  • The likelihood of having a hospice in the county increased with a higher number of physicians, but decreased with a higher median age of the residents or a higher percentage of residents living in poverty. In urban counties, the likelihood increased with a greater percentage of black, Hispanic, and Asian residents.
  • These findings indicate that the availability of both physicians and hospices is often lower in rural counties or those with older residents and higher poverty, which may create a barrier to use of the MHB and limit access to hospice services.    

Campbell CL, Merwin E, Yan G. Factors that influence the presence of a hospice in a rural community. Journal of Nursing Scholarship. 2009; 41: 420-428.