Hospice care facilities provide care for the terminally ill, including patients battling late-stage cancer, heart disease, and kidney failure, as well as those living with chronic non-healing wounds. In this article, The Wound Pros examines the effects of inequities in hospice care and proposes viable solutions to close the gap.
Disparities in COVID-19 cases and mortalities in the U.S.
As the number of COVID-19 hospitalizations reaches record highs across the country, disease risk and mortality rates among minorities have reached unprecedented levels. Within U.S. states, the contrast is apparent. In Chicago, for example, over 50% of the reported cases and over 70% of fatalities are among African American populations. COVID-19 related mortality is six times higher in Black Americans than whites in Washington DC, five times higher in Missouri and Michigan, and three times higher in Louisiana, Illinois, and New York.
Moreover, a report by a leading peer-reviewed journal has revealed that minority populations are underserved at hospice care facilities. The study used data from Medicare beneficiaries to collate numbers of admissions, hospice enrollment/dis-enrollment, and emergency department (ED) visits in whites and people of color. The researchers discovered several racial disparities in patterns of care between black and white enrollees. If these issues are left unaddressed, they may likely worsen over time.
Inequities in hospice care and under-utilization by minorities
Social distancing and non-contact measures adopted across the country to slow the spread of the virus has adversely affected the amount of care many patients receive at long-term care facilities, particularly those without symptoms that are considered life-threatening. However, inequities in long-term facilities such as hospice homes are more pronounced among minorities such as African Americans, Native Americans, and Hispanic peoples. The problem has today come to the fore during the pandemic.
According to Sherita Hill Golden, M.D. in an article on Hospice news: (“[The rates of pandemic infections and deaths] highlight the social and health inequities in a way that it just makes them glaring." For many of us who have worked with these populations, they have been dying at higher rates for heart disease, diabetes, and renal disease for years. But those are the chronic diseases, so people die more slowly, whereas [COVID-19] is an acute infection.”), she added. According to a study by the Association of Health Care Journalists (AHCJ), end-of-life racial and diagnostic differences at hospice facilities may account for the lower ratings black families award hospice care in their communities.
Underutilization of hospice care facilities correlates with mistrust of the healthcare system by minorities. Research has revealed systematic racial variations in the intensity of care received at hospice facilities. Drawing data from more than 145 thousand Medicare beneficiaries followed until death, in 577 hospice care facilities, a survey revealed that Blacks were more likely than whites to be admitted, visit the emergency department (ED), and disenroll after hospice enrollment.
Democratizing wound management at hospice care facilities
One of the best ways to democratize care at long-term care facilities is via virtual healthcare (telehealth). It involves utilizing electronic hardware and information technology for the delivery and facilitation of health-related services. Telehealth is particularly beneficial to the vast majority of patients (regardless of race, class, or social status), that own mobile or portable devices.
The Wound Pros provides wound care at long-term care facilities as well as Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS). We use a high-tech approach to wound care that can help to bridge the gap in hospice care to underserved populations. We provide care for patients in hospice care facilities living with chronic non-healing wounds such as diabetic foot ulcers, leg ulcers, and pressure wounds. Telehealth services are accessible via The Wound Pros platform, which gives patients real-time access to specialized care teams. By using high-definition video from a smartphone or tablet camera, clinicians can diagnose or monitor the status of inpatients' wounds in hospice facilities, recommend treatment protocols, or prescribe wound dressings remotely.
Moreover, we recently announced the introduction of RITA, a remote vitals monitoring app for early detection of COVID-19 in patients and healthcare workers at long-term care facilities. It utilizes a smartphone camera and artificial intelligence (AI) to track variations in residents' vital signs, such as oxygen saturation, heart rate, heart rate variability, mental stress, and blood pressure (soon to be added).