Community-based hospice and palliative care programs play a critical role in improving access to serious illness care, particularly for communities that have historically experienced disparities in healthcare.
By Alicia Bloom, Empassion COO
(Ed. Note: Recent policy discussions around expanding access to community-based palliative care underscore the growing recognition that patients with serious illness often need support well before hospice eligibility.)
The recently released 2025 edition of Hospice Facts and Figures report from The National Alliance for Care at Home, in collaboration with the Research Institute for Home Care, offers a comprehensive look at how end-of-life care was delivered in 2024. While the data shows a record 1.91 million Medicare beneficiaries accessed hospice services — a 4.4% increase from the previous year—a deeper look at the demographics reveals that geography is far from the only barrier to care. When we talk about access to care, we often default to geography. Rural provider shortages, transportation challenges, and hospital closures are very real barriers to receiving any health care services, including timely access to palliative care or hospice services. Yet geography is only one dimension of access. Cultural familiarity, language, and trust in the healthcare system can be just as important — particularly when families are navigating the emotionally complex decisions that come with serious illness.
The Data on Disparity
Despite the overall growth in hospice utilization, significant disparities persist across racial and ethnic lines. In 2024, 55.8% of White Medicare decedents accessed hospice care. In contrast, utilization rates were significantly lower for Hispanic (41.2%), Black (40.5%), North American Native (40.2%), and Asian American (39.4%) beneficiaries. While White decedent use dipped to 50% during the pandemic, no other race or ethnicity has exceeded a 45% utilization rate in any observed year, typically trailing White decedents by 15 percentage points.
These figures underscore a critical point: access to serious illness care is about more than just having a provider nearby; it is about trust and cultural alignment.
Beyond Geography: Trust and Familiarity
A recent article in the Sacramento Observer, “Demystifying the End: Hospice Care Impact on the Black Community,” highlights that many communities face barriers rooted in mistrust, skepticism and a lack of familiarity with the system. As the Facts and Figures report illustrates, these persistent patterns of disparity warrant further investigation and intervention.
Even in urban areas where providers are plentiful, cultural familiarity remains a primary driver of hospice access and engagement with community-based hospice providers. When families misunderstand hospice as “giving up” or associate it with distant, unfamiliar institutions, the opportunity for compassionate, dignified care is lost. The Medicare hospice benefit was specifically designed to prioritize comfort and quality of life, yet these benefits cannot be fully realized if services are introduced only in a patient’s final days. Without a clear understanding of the support available, patients and their families miss the window for interventions that provide the most significant impact.
Trust also plays an important role. For families who have experienced inequities in healthcare, skepticism toward the system is understandable. Even in communities without that history, patients often feel more comfortable receiving hospice or palliative care from organizations that understand local traditions and dynamics.
This is why community-based care models matter.
The Power of Community-Based Models
Across the country, many of the most effective serious illness programs are built around providers who are deeply embedded in the communities they serve. These organizations often have longstanding relationships with local physicians, faith leaders, and social service organizations. Their clinicians speak the same languages as the patients they care for, understand cultural expectations around caregiving, and recognize that each family will approach difficult medical decisions uniquely.
Earlier access to community-based palliative care from trusted local providers can facilitate earlier conversations about serious illness. When care is rooted in the community, patients and their families are more likely to receive supportive services like palliative care sooner, rather than only in a moment of crisis. This means more thoughtful advance care planning discussions and care that is concordant with goals, preferences and values.
Community-based models also help address the wide diversity of needs across different regions. Patients and families in a rural town in the Midwest may face very different challenges than an urban neighborhood on the West Coast or a coastal community in the Southeast. Care teams who are part of those communities are often best positioned to adapt services accordingly — whether that means coordinating care across long distances, working closely with local faith-based and community organizations, or ensuring care is accessible in multiple languages.
Redefining Access
Improving hospice access is not just about increasing the number of Medicare-certified hospices (which grew to 6,691 in 2024). It is about ensuring those services resonate with the people receiving them. As we look toward the future of hospice care, our goal must be to design care models that reflect our communities—geographically, culturally, and socially.
Serious illness care is ultimately about supporting patients and families during some of the most difficult moments of their lives. That support must extend beyond clinical expertise, as it requires empathy, cultural understanding, and relationships built over time, not just in the final days of life.
As conversations about hospice and palliative care continue to evolve, it is worth remembering that improving access is not only about increasing capacity. It is also about designing care models that reflect the communities they serve — geographically, culturally, and socially.
When care is rooted in community, patients and families are far more likely to receive the support they need, when they need it most.And that is something every healthcare system should aspire to achieve.
Redefining Access
Alicia Bloom is Chief Operating Officer of Empassion, a national leader in serious illness and hospice care.
