For more information about the author, click to view their website: VITAS Healthcare
By Dr. Joseph Shega, Chief Medical Officer, VITAS Healthcare
Hospice provides myriad benefits to patients nearing the end of life: improved quality of life, better symptom and pain control, and greater patient and family satisfaction. However, despite increases year over year in the number of beneficiaries who used the Medicare Hospice Benefit, hospice remains underutilized in some patient populations. Two such populations present an opportunity for improvement: inpatients placed on Comfort Measures Only (CMO) and patients of color. Both groups face unique barriers to accessing hospice care.
Most hospice care (more than 98%) occurs in the home, whether a private residence, assisted living community, or nursing home. However, when a hospice patient’s symptoms can no longer be managed at home, they may move to a General Inpatient Care (GIP) setting for a short period of time to manage acute symptoms and pain. Despite being one of the four levels of hospice care required by Medicare-certified hospice organizations, GIP care remains uncommon. According to National Hospice and Palliative Care Organization (NHPCO) data, in fiscal year 2022, GIP comprised only 0.88% of Medicare days of care.1

This need for an enhanced level of care is particularly evident when examining hospitalized patients on Comfort Measures Only (CMO), or comfort care—a population that may widely benefit from being admitted to GIP care to manage their pain and other symptoms before returning home to receive routine hospice care.
A 2023 retrospective cohort study by Kozhevnikov et al. showed that around 22% of studied patients who transitioned to CMO status during their terminal hospital admission received general inpatient hospice care before death.2 CMO decedents who died without GIP during their terminal hospitalization were more likely to die in an ICU, have a lower Rothman Index (i.e., a higher risk of adverse events, clinical deterioration, and worse outcomes), and spend less time with CMO status.2 Further, without hospice care, families do not receive the 13 months of bereavement support that hospice provides after the patient’s death.
Improving access to GIP hospice care among patients on CMO and awareness among care team members will result in more patients being able to benefit from the specialty symptom management, treatment of psychological and spiritual distress, and bereavement support that hospice can provide.
Along with the barriers faced by CMO patients, racial disparities play a significant role in the underutilization of both palliative and hospice care, particularly among minority groups.
A 2024 study by Cid et al. found that minority patients were less likely than White patients to have documented end-of-life care during terminal hospitalizations.3 Using palliative care encounters and do-not-resuscitate (DNR) status as metrics for end-of-life care, the study showed that, compared to White patients, Black patients were 17% less likely to have palliative care encounters and 9% less likely to have DNR status.1
Going beyond this study's metrics, racial disparity can also be seen in hospice utilization. The NHPCO found that among Medicare decedents in 2022, hospice use occurred in 51.6% of White Medicare decedent beneficiaries, but among only 38.3% of Hispanic decedents, 38.1% of Asian-American decedents, 37.4% of Black decedents, and 37.1% of North American Native decedents.1
Improving these metrics may begin with goals-of-care conversations. Initiated by clinicians, these conversations help uncover a patient’s wishes, values, and care preferences. From these discussions, we can help inform patients and their families about their options for end-of-life care, including hospice.
It is our duty as clinicians to have these conversations early and often with our seriously ill patients and their families, so they are well-informed of the care choices available as their disease continues to progress. Healthcare professionals should ask open-ended questions to understand what matters most to patients facing serious illness.
For minority groups, approaching these conversations in a culturally sensitive and respectful manner is paramount. This may include considering language preferences, understanding specific cultural or religious beliefs around illness and death, and involving family members in the decision-making process.
Over the years, hospice awareness and utilization have grown, but it remains underutilized among terminally hospitalized patients on CMO and patients of color. These two unique populations present their own challenges and opportunities regarding access to hospice, highlighting the need for effective goals-of-care conversations to increase hospice awareness and accessibility.
By fostering culturally sensitive conversations that increase awareness of the Medicare Hospice Benefit, we ensure that patients and families from all backgrounds have the option to receive the compassionate, equitable end-of-life care they deserve. These efforts will help bridge disparities and improve the quality of care for countless individuals and their families.
1. National Hospice and Palliative Care Organization. NHPCO Facts and Figures. 2024. Available from: https://www.nhpco.org/hospice-facts-figures [Last accessed: September 11, 2024].
2. Kozhevnikov D, et al. Factors associated with inpatient hospice utilization among hospitalized decedents with comfort measures only status. Journal of Palliative Medicine. 2023;26(8):1048-1055. doi:10.1089/jpm.2022.0460
3. Cid M, et al. Disparities in end‐of‐life care for minoritized racial and ethnic patients during terminal hospitalizations in New York State. Journal of the American Geriatrics Society. Published online July 10, 2024. doi:10.1111/jgs.19046
When it comes to choosing a senior living community, finding the right balance of personalized care, wellness, engaging experiences, and comfort is essential. At The Watermark at Marco Island, residents can enjoy a thoughtfully designed lifestyle in a beautiful setting while receiving support tailored to the way they want to live.A Place to Call Home on Marco IslandLocated at 1170 San Marco Road in Marco Island, Florida, The Watermark at Marco Island offers assisted living and memory care in a welcoming residential environment.The community is designed to provide more than just a place to live. Here, personalized care is complemented by opportunities for wellness, enriching daily experiences, social connection, and chef-prepared dining.For seniors and their families, that means having support available while maintaining independence and enjoying the lifestyle that makes each day meaningful.Personalized Care Designed Around YouEvery resident has unique needs, interests, routines, and preferences. The Watermark at Marco Island takes a personalized approach to care, creating support around the individual rather than expecting residents to fit into a one-size-fits-all model.Whether a senior needs assistance with daily activities or specialized support associated with memory care, the goal is to help residents feel comfortable, confident, and engaged in their surroundings.This thoughtful approach allows families to have greater peace of mind while their loved ones enjoy a community designed around their well-being.Wellness and Enriching ExperiencesLife at The Watermark at Marco Island extends beyond care. The community incorporates holistic wellness and enriching daily experiences designed to encourage residents to remain active, connected, and engaged.Common areas provide opportunities to socialize with friends, participate in activities, enjoy hobbies, or simply relax in a comfortable environment. From a game of pool to sharing a meal or spending time with neighbors, residents have opportunities to make each day their own.The emphasis is on supporting the whole personmind, body, and spirit.Dining Made From ScratchGood food is an important part of a fulfilling lifestyle, and dining at The Watermark at Marco Island is designed to be an enjoyable part of each day.Residents can experience chef-prepared meals made from scratch, offering the opportunity to enjoy delicious food while dining in a social and welcoming environment.Meals can be more than simply meeting nutritional needsthey can provide residents with another opportunity to connect, celebrate, and enjoy the pleasures of everyday life.Comfortable ResidencesThe Watermark at Marco Island offers thoughtfully designed residences intended to provide comfort, privacy, and a sense of home.Bright interiors, comfortable furnishings, and inviting living spaces create an environment where residents can settle in and feel at ease. Families can visit and spend quality time with their loved ones in a setting that feels warm and welcoming.The community's design also provides convenient access to shared spaces where residents can socialize and participate in daily activities.See Your Day HereChoosing senior living is a significant decision, and seeing a community in person can make all the difference. A personal visit allows seniors and their families to experience the environment, explore the residences, learn about available care, and get a better understanding of everyday life at the community.The Watermark at Marco Island invites prospective residents and their families to step inside, tour the residences, and picture what their day could look like here.To schedule a personal visit, call 239-999-4601.The Watermark at Marco Island1170 San Marco RoadMarco Island, FL 34145WatermarkMarcoIsland.com
Moving a parent to senior living is rarely just a move. It is an emotional transitionfor the older adult, the family, and often the person making the decision.Families may feel guilt, sadness, fear, relief, and even uncertaintysometimes all in the same day.A daughter may think, Am I doing the right thing?A son may wonder, Will Mom think Im abandoning her?And a parent may be thinking, Am I losing my independence?These emotions are normal.As senior living leaders, our responsibility goes beyond providing a safe apartment, meals, activities, and care. We have to care for the emotional journey that comes with the transition.Its not about taking independence away.Its about helping redefine what independence looks like.Sometimes independence means no longer worrying about cooking, cleaning, medication management, or being alone. It means having people nearby, opportunities to socialize, and support when it is neededwhile still having choices about how each day is lived.Families need reassurance, not judgment.The decision to move a parent is often made after monthsor yearsof difficult conversations, falls, sleepless nights, increasing care needs, or simply realizing that living alone isnt working anymore.Families dont need someone to make them feel guilty.They need someone to say:Youre not failing your parent. Youre helping create a safer, more supported chapter of their life.The first days matter.A successful transition isnt just about getting someone moved in.The process starts before they move in. Person Centered Selling truly makes a difference from an average senior living to a fantastic senior living. It is about learning who they are.What makes them smile?What did they do for a living?What music do they enjoy?What foods do they love?Who are the important people in their life?What makes them feel comfortable?When we know the person behind the resident, we can begin creating a sense of belonging, not just care. And sometimes the greatest measure of success isnt the beautiful apartment or the activity calendar.Its when a family member says:I havent seen Mom this happy in a long time. That is priceless! That is when we know the transition is becoming a new beginning.From a senior living leaders perspectiveI have learned that families arent simply looking for a place for Mom or Dad.They are looking for peace of mind.They want to know their loved one is safe.They want to know someone will notice when something isnt right.They want their parent to have friends.They want to be a daughter or son againnot a full-time caregiver.And most importantly, they want to know:Will you love and care for my parent when I cant be there?That is the promise behind great senior living like Springwood Court. Because at the end of the day, we arent just helping someone move into a community.Were helping a family move into a new chapter and season of their life, one filled with support, connection, dignity and love.Fran Gray RNExecutive Director Springwood CourtAssisted Living12780 Kenwood LaneFort Myers, FL33907239-278-0078
Naples, Fla. Behind Naples' image as one of Florida's most affluent communities lies a growing and often invisible crisis: a rising number of seniors who can no longer afford both groceries and essential bills. As Collier County's population continues to age rapidly, local hunger-relief organizations are reporting that older adults are becoming one of the fastest-growing groups in need of food assistance.A County Growing Older, FasterCollier County is already one of the oldest counties in Florida, with 36 percent of residents age 65 or older a figure expected to climb to 46 percent by 2050. While the county's overall poverty rate sits at roughly 10.7 percent, a closer look reveals a more troubling picture for older adults: nearly a third of Collier County seniors live below the ALICE Survival Budget threshold, the income level required to cover basic necessities such as housing, food, transportation, and health care. For a single older adult, that threshold is $26,680 a year; for a couple, $45,564 figures that fall far short of what many face in a high-cost coastal market like Naples.Many of these seniors live on fixed incomes from Social Security or modest pensions that have not kept pace with rising housing and condo fee costs, property insurance premiums, and medical expenses. Meals of Hope Seeing the Shift and The Glenview at Pelican Bay is Ready to HelpUnlike younger families facing food insecurity, senior hunger often goes unseen. Many older adults are reluctant to ask for help due to pride, limited mobility, or simply not knowing where to turn. Meals of Hope, the Naples-based hunger relief nonprofit founded by President and CEO Stephen Popper in 2007, is one of the organizations seeing this shift firsthand and The Glenview at Pelican Bay has a personal connection. Stephens mother, Christine Popper, who is a current resident at The Glenview at Pelican Bay and a former nurse, came up with the idea 19 years ago. My mother saw a need to support a school in Haiti but found that the children couldnt learn because they did not have enough to eat, remarked Steve, I did some research, learned about meal packing opportunities, and hosted an event in Naples in August 2007 where 500 volunteers showed up to pack 135,000 meals. That event was life-changing, and Meals of Hope was born. The Glenview at Pelican Bay is a willing and regular packing partner and the next Meals of Hope event will take place on Monday, August 24 at 1pm. The press is invited to watch the process. Now the largest food pantry network in Southwest Florida, Meals of Hope operates roughly 21 weekly food pantries across Collier and Lee counties and distributes more than 125 million meals each month, serving approximately 4,000 families a week. Popper notes that older adults on fixed incomes are showing up in growing numbers, often for the first time in their lives, as inflation and rising local housing costs erode the purchasing power of Social Security checks.How The Glenview at Pelican Bay Is RespondingBesides housing the idea person behind this effective community service, The Glenview at Pelican Bay partners with Meals of Hope regularly with residents who volunteers hundreds of hours of time to organize, sort and pack meal boxes. They will be doing it again this month on Monday August 24 at 1pm. We feel it is important to support our community in every way, adds Daniel Gomez, Glenviews Executive Director, We are so proud to have Mrs. Popper among our residents and it has become something our residents and staff look forward to helping with.It will be a family affair for the Poppers as Christine, her son Steve, his wife, their children and her grandchildren will be among the volunteers. Notes the Matriarch Christine Popper, It is a wonderful way to teach our children about community service and I get a nice visit out of it as well. I am so grateful for The Glenview at Pelican Bay and how they readily embrace helping the community.In addition to regular packing events, Meals of Hope has expanded its infrastructure and reimagined how it reaches vulnerable seniors and families, including:A new 18,000-square-foot distribution center in Naples, featuring more than 9,000 square feet of refrigerated space to store fresh produce, proteins, and dairy at a much larger scaleYour Neighborhood Pantry, a mobile "choice" pantry launched with support from the Collier Community Foundation, where residents walk through and select their own groceries including fresh produce, dairy, eggs, and proteins preserving dignity and reducing wasteNeighborhood-based mobile pantries, including a location at the River Park Community Center currently serving close to 100 families per week, with room to grow to 160A Home Delivery Initiative aimed at reaching homebound residents in Immokalee and Golden Gate who face transportation or mobility barriers that a traditional pantry can't solveThe Hunger to Hope capital campaign, which has raised $2.8 million toward a $4.5 million goal to fund long-term infrastructure behind this workStarting and watching Meals of Hope grow and help so many people has been life changing for me and my family, Steve added. And, it just goes to show, listen to your mother because she knows what is right. About The Glenview at Pelican BayThe Glenview at Pelican Bay is Naples' only equity-ownership LifeCare community, offering residents a rare combination of financial security, resort-style living, and access to award-winning care all within one of Florida's most desirable coastal settings. Managed by Life Care Services (LCS), ranked No. 1 in customer satisfaction among independent senior living communities by J.D. Power, The Glenview delivers an exceptional standard of living at every level. Residents enjoy chef-driven dining and a rich calendar of activities and enrichment programs, all steps from home. For those who need it, Premier Place the community's on-site health center provides a full continuum of care. For more information, visit glenviewnaples.com or call (239) 977-9744.
VITAS Hospice Fort Myers Office (Lee, Glades & Hendry Counties, FL)The VITAS Fort Myers Hospice Office, located at 12751 Westlinks Drive, Fort Myers, FL 33913, serves as the central care coordination hub for patients and families throughout Lee, Glades, and Hendry counties.As the local home base for the interdisciplinary team including physicians, nurses, home health aides, social workers, chaplains, and volunteers this office ensures seamless, compassionate support for patients and caregivers.What We DoDeliver hospice care where people live: private homes, assisted-living facilities, nursing homes, and wherever comfort is needed.Provide access to inpatient hospice units, such as the one at Lee Memorial Hospital, for patients whose symptoms require more intensive management.Offer staff availability 24/7 to answer questions, manage symptoms, and adapt care plans as needed.Treat the whole person emotionally, spiritually, and physically with care tailored to each patients goals and dignity.Contact & AccessPhone: (239) 744-2300Hours: Office maintains business hours, but clinical support is available around the clock.Service Area: Lee, Glades, and Hendry counties, Florida.
VITAS Hospice Fort Myers Office (Lee, Glades & Hendry Counties, FL)The VITAS Fort Myers Hospice Office, located at 12751 Westlinks Drive, Fort Myers, FL 33913, serves as the central care coordination hub for patients and families throughout Lee, Glades, and Hendry counties.As the local home base for the interdisciplinary team including physicians, nurses, home health aides, social workers, chaplains, and volunteers this office ensures seamless, compassionate support for patients and caregivers.What We DoDeliver hospice care where people live: private homes, assisted-living facilities, nursing homes, and wherever comfort is needed.Provide access to inpatient hospice units, such as the one at Lee Memorial Hospital, for patients whose symptoms require more intensive management.Offer staff availability 24/7 to answer questions, manage symptoms, and adapt care plans as needed.Treat the whole person emotionally, spiritually, and physically with care tailored to each patients goals and dignity.Contact & AccessPhone: (239) 744-2300Hours: Office maintains business hours, but clinical support is available around the clock.Service Area: Lee, Glades, and Hendry counties, Florida.
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they call home, including but not limited to: private homes, senior living communities, and long term care facilities in Southwest Florida. We have offices located in Collier and Lee County and an Inpatient Unit in Naples. Coming soon, VITAS Inpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and families need it.At VITAS, we prioritize our patients and their families above all else. By concentrating on enhancing quality of life, managing symptoms and pain effectively, and minimizing 911 calls and hospital readmissions, we ensure our patients' comfort and well-being. VITAS distinguishes itself from traditional hospice providers through a personalized approach to care planning, transparent medication management, and a comprehensive range of specialized modalities tailored to meet diverse patient needs. These include physical therapy, occupational therapy, speech therapy, respiratory therapy, wound care, palliative oncology therapy, palliative dialysis, and more. Office Locations:Fort Myers VITAS Hospice Office12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit at Solaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N. Tamiami Trail, Suite 102, Naples 34103 Our Care ServicesAt VITAS we care for patients with an interdisciplinary team comprising a nurse, physician, aide, social worker and chaplain. Our teams design personalized care plans to ensure comfort, dignity and quality of life. Hospice Care at Home Condition-Specific Care 24/7 Telecare Intensive Comfort Care Veterans Care Inpatient Hospice Care Music Therapy Paw Pals Pet Visits Grief and Bereavement Support