MedicalResearch.com Interview with:
Nathan A. Gray, M.D.
Duke Palliative Care
Durham, NC 27710
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: The estimated number of undocumented immigrants living in the United States has been stable in recent years, but lengths of residence in the country are rising. This aging population of undocumented immigrants can expect to face an increasing burden of chronic disease and end-of-life needs, but may experience challenges in obtaining hospice care in the last months of life as many are uninsured and none are eligible for the Medicare Hospice Benefit. While hospice agencies do provide charity care, little is known about hospice agency approaches to caring for undocumented immigrants.
We surveyed a national sample of hospice agencies and found that many hospice agencies do not enroll undocumented immigrants or place restrictions on the number enrolled. More than half of agencies sampled had received requests for enrollment of undocumented immigrants in the past year. Offering unrestricted enrollment was more common among larger, not-for-profit hospices in our sample.
MedicalResearch.com: What should readers take away from your report?
Response: Hospice services may be difficult to access for undocumented immigrants, particularly those living in areas served predominantly by smaller, for-profit hospices who may be unable to take on the financial burden of caring for patients who do not have coverage to pay for their services.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: This is an inherently difficult population to study, given obvious barriers to consistent identification of such patients and lack of standardized data regarding their care. Prior to considering policy changes to enhance hospice access among undocumented immigrants, it would be helpful to clarify the actual need for such services among undocumented patients and to determine the added costs to health systems that are posed by attempting to provide end-of-life care without hospice support. Enhancing access to hospice for undocumented immigrants could conceivably reduce total costs for health systems if it allowed reduction in emergency department visits or hospitalizations related to end-of-life care.
MedicalResearch.com: Is there anything else you would like to add?
Response: While current political discourse offers a wide variety of thought on the best approach to caring for those living amongst us who are undocumented, the realities faced by health systems and providers trying to care for undocumented immigrants who are at the end of life demand a thoughtful approach which addresses both the basic needs of patients who are suffering at the end of life and the economic needs of health systems that must find effective ways to care for such patients. Prior research showing the cost-effectiveness and quality delivered by hospice care suggests that readily available access to hospice could meet both of these needs compassionately.
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