Racial gap in hospice use, advanced care planning expected to grow

Only a third of eligible black Medicare beneficiaries enroll in hospice compared to half of white beneficiaries, a racial gap that is expected to grow, according to a new report from Kaiser Health News.

The gap in advanced care planning is even wider. There are around 40% of white seniors over age 70 with legal documents related to their care plans, compared to 16% of black seniors. Medicare's move towards paying physicians to have end-of-life discussions with patients may widen the difference, researchers said.

That difference may reflect access to providers, lack of health insurance or patients living in poverty, experts said.

“You have people who've had a difficult time getting access to care throughout their lifetimes, and then you have a physician who's saying, ‘I think that we need to transition your mother, father, grandmother to comfort care or palliative care,'” Maisha Robinson, M.D., a neurologist and palliative medicine physician at the Mayo Clinic in Jacksonville, FL, told Kaiser. “People are skeptical of that.”

As more minority seniors become eligible for Medicare - up to 42% of those over age 65 by 2050 - the gap in hospice and advance care planning may widen, researchers said.