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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 Rachel Ritter first walked through the doors of The Glenview, she wasnt leading concerts, organizing excursions, or planning community-wide celebrations.She was 15 years old, bussing tables in the dining room.Today, more than three decades later, Rachel has come full circle as The Glenviews new Lifestyle Director a role that perfectly combines her lifelong dedication to the community with her passion for enriching the lives of residents.Along the way, Rachel earned both a nursing degree and a degree in history, supported in part by a scholarship from The Glenview Scholarship Fund. She worked at The Glenview throughout college, held numerous leadership roles in Dining Services, and built lasting relationships with residents and team members alike.Now, she has found what she calls her true calling.After 31 years at The Glenview, Ive discovered that my greatest passion is creating a vibrant lifestyle for our residents, said Rachel. Dining Servies allowed me to create exceptional experiences around the table, but I wanted to contribute even more to daily life here. My goal is simple: every resident should wake up each morning with something exciting to look forward to.That philosophy is reflected in every square of The Glenviews bustling Activities Calendar. A Calendar Packed with PossibilityRachels vision is ambitious: create enough variety that every resident can find something that sparks joy, curiosity, connection, or purpose.Its my job to bring joy to peoples lives, said Rachel. I take that responsibility very seriously.Each month, residents enjoy an extraordinary mix of entertainment, education, wellness, social events, and excursions. Signature Events & EntertainmentTwo to three major events each month bring the community together for unforgettable experiences. From jazz ensembles and classical concerts to vocal performances and thought-provoking lectures by college professors, residents can explore topics ranging from history and philosophy to pop culture and current events. Culinary ExperiencesFood lovers eagerly await the monthly cooking demonstrations led by Executive Chef David Chidsey or Pastry Chef Ashley Yedeski. Residents learn professional techniques, enjoy generous tastings, and occasionally see favorite recipes make their way onto the dining room menu.The culinary fun continues with themed luncheons and tea parties. Recent favorites have included French and Asian-inspired lunches, farm-to-table seasonal luncheons, a Southern Tea Party, and a whimsical Mad Hatter Tea complete with imaginative desserts.Ashley has a gift for creating memorable pastries, said Rachel. Together, we love finding ways to surprise residents with something delicious and unexpected. Wellness for the Whole PersonAt The Glenview, wellness extends far beyond exercise.Working alongside Director of Health & Wellness Navigation Kari Bone, Rachel helps create programming that supports all eight Dimensions of Wellness: physical, emotional, social, spiritual, intellectual, vocational, health services, and environmental health.Recent speakers have included cardiologists, dietitians, meditation specialists, IT & fraud advocates, and other experts all lectures paired with refreshments and opportunities for discussion.Our residents are incredibly curious and engaged, said Kari Bone. Its a pleasure working with Rachel to bring in exceptional speakers on topics that matter most to the quality of life for our seniors. Lifelong learning is alive and well at The Glenview!Residents can also choose from 13 fitness classes every week, including yoga, meditation, cardio exercise, balance training, chair fitness, Tai Chi, and specialized classes led by physical therapy professionals. For independent workouts, the Fitness Center offers access to state-of-the-art equipment seven days a week. Adventure Awaits in Pelican BayWhile there is always something exciting happening on campus, Rachel also loves taking residents on the road. Recent outings have included a Rhythm & Blooms Jazz Concert at the Naples Botanical Garden, rooftop happy hour at The Perry Hotel, and visits to every new exhibition opening at the Artis Naples Museum.Rachel also coordinates transportation for residents who are season ticket holders for Naples Players productions and Artis Naples Masterworks Concerts.One of the best parts of my job is helping residents continue exploring the community they love, said Rachel. Theres always another adventure waiting in Pelican Bay. The Power of Shared InterestsSome of the communitys most beloved activity programs are resident-led. Book lovers can join either the Fiction Book Club, led by resident Lynn Nolan, or the Non-Fiction Book Club, led by resident Cynthia Bye. Creative residents can gather for the Social Crafting Bee, where simple projects are paired with cookies, lemonade, and conversation. The newest project a handmade greeting card was suggested and organized by resident Carol Levy.The Card Room is always a hub of activity at The Glenview. Card players gather regularly for bridge, Mexican Train, mahjongg, and other favorite games, while movie enthusiasts enjoy Saturday matinees complete with buttered popcorn.Rachel has a remarkable talent for turning resident ideas into reality, said Lynn Nolan, resident and Chair of the Lifestyle Committee. She listens, encourages participation, and helps create the sense of community that makes The Glenview so special. Rachel is much loved by all our residents. Giving Back TogetherSome activities focus on something even bigger than fun.Through a partnership with Meals for Hope, residents participate in quarterly philanthropy events that help organize and distribute food for local families in need.Many residents want hands-on ways to serve others, Rachel said. This program allows them to make a direct impact while working together as a community.The Glenview knitting group has found a similarly meaningful mission by connecting with the global non-profit Knitted Knockers, where they create soft knitted prostheses for women recovering from breast surgery.Its amazing to watch residents use their talents to comfort someone theyve never met, said Rachel. The project gives purpose to every stitch. A Scholarship That Came Full CircleOne activity especially close to Rachels heart is the monthly Scholarship Bingo fundraiser. All proceeds benefit The Glenview Scholarship Fund, which helps employees further their education.I was fortunate enough to receive one of those scholarships myself, said Rachel. It changed the course of my life. Every time we host Scholarship Bingo, Im reminded of how much this community invests in its people. Always Looking AheadRachel is already looking to expand the already full Activities Calendar.A new Dining Out Club is in development, giving residents opportunities to explore local restaurants together. Rachel is also working with yoga instructor Marjorie to launch a Senior Salsa class and continues partnering with the resident-led Lifestyle Committee to bring new ideas to life.The best ideas often come from residents, said Rachel. When people share their passions, we can create even more opportunities for connection and fun.Resident Judy Johansen agrees. Rachels enthusiasm is contagious, said Judy. She creates opportunities for everyone to get involved, make friends, and try something new. Theres always something exciting on the horizon here.For Executive Director Daniel Gomez, Rachels impact is impossible to miss. Rachel brings tremendous energy, creativity, and heart to everything she does, said Daniel. Her decades of experience at The Glenview, combined with the genuine relationships shes built with residents, make her truly irreplaceable. She helps create the culture of joy that defines this community.Rachel sums up her vision with characteristic enthusiasm: I want The Glenview to feel like a cruise ship that never leaves the dock, she said. There should always be great food, lively conversation, and exciting activities waiting around every corner!Judging by the packed calendar and the smiles it creates Rachel has certainly contributed to making The Glenview a destination of choice for seniors.We invite you to experience The Glenview personally. Join us for lunch, tour the community, meet the residents, and see firsthand why so many discerning individuals choose to call it home.To learn more about our community or schedule a visit, call us at (239) 977-9744 or complete our Contact Us form.
When you move to The Glenview, youre gaining more than a beautiful apartment home. Youre gaining a trusted guide dedicated to helping you stay healthy, connected, independent, and confident as you embrace this exciting new chapter.That guide is Kari Bone, Director of Health & Wellness Navigation.My goal is simple, Kari said. I want every resident to feel supported, confident, and excited about whats ahead. Whether someone needs help finding a new physician, has questions about available services, or wants to learn new ways to stay healthy and active, Im here for them.Its a role thats part educator, part advocate, part problem-solver and one that helps residents truly optimize life at The Glenview.Wellness That Helps You Live Your Best LifeWellness at The Glenview isnt measured by the number of fitness classes on the calendar. Its about creating opportunities to live with greater purpose, energy, and peace of mind. Kari develops engaging programming that supports all eight Dimensions of Wellness physical, emotional, social, spiritual, intellectual, occupational, financial, and environmental health giving residents new ways to learn, connect, and thrive.On the first Wednesday of every month, residents gather for Health & Wellness Presents, a popular speaker series featuring physicians, therapists, dietitians, wellness experts, and other specialists discussing topics that matter most as we age.Our residents are incredibly curious, Kari said. Every month we have a wonderful turnout because people genuinely enjoy learning something new. They ask great questions, share their experiences, enjoy a healthy lunch or cooking demonstration, and spend time with friends. You leave feeling a little smarterand a little happier.Recent presentations have explored everything from heart health and nutrition to mobility, meditation, fraud prevention, and healthy aging. Interactive demonstrations and lively discussions turn every program into an opportunity to learn something practical while building meaningful friendships.Between presentations, Kari also shares practical advice through her popular Navigator Nuggets easy-to-save wellness guides included in the monthly resident newsletter. Covering topics like hydration, fall prevention, and seasonal wellness, theyre another way The Glenview helps residents make informed choices that support healthy, independent living.More Than Answers Peace of MindKari also introduces residents to the many services available to support successful aging in place, including GlenCare, The Glenviews personalized in-home support program.I never want someone to feel like theyre on their own, Kari said. Whatever question comes up, whatever challenge they face, well figure it out together. Thats what were here for.That reassurance begins long before move-in day.Kari is a results-driven leader with a humanitarian heart, said Krisandra Panting, Director of Marketing & Sales. Shes an incredible resource for prospective residents and their families because she has a solution for virtually every question or concern. She has a remarkable way of helping people feel comfortable, cared for, and confident about their decision to move to The Glenview.Helping Residents ThriveThis October, Kari will launch LifePlus, an exciting new wellness initiative built around four pillars of healthy aging: Connection, Movement, Nutrition, and Longevity. The program debuts with a week-long celebration featuring presentations given by nationally recognized physicians, wellness talks, fitness classes, interactive demonstrations, pop-up events, and the One Million Step Challenge, where residents join forces to track their steps throughout the month, turning walking and healthier habits into a shared community goal.Kari brings so much heart to everything she does, said Daniel Gomez, Executive Director. She doesnt just organize outstanding programs she builds relationships. She helps people discover new interests, make new friends, and feel confident that theyre supported every step of the way. Her guidance is one of the many things that makes life at The Glenview so special.For Kari, thats the real purpose behind every program, every conversation, and every connection.When someone chooses The Glenview, theyre choosing so much more than a place to live, she said. Theyre choosing a community that wants them to feel their best, keep learning, stay connected, and enjoy every stage of life. Seeing residents discover new friendships, new interests, and new confidence thats why I love what I do.Optimizing your life isnt about doing more. Its about living in a community where youre encouraged to be healthier, stay curious, build meaningful relationships, and embrace each day with confidence.Thats the difference youll discover at The Glenview.We invite you to experience The Glenview personally. Join us for lunch, tour the community, meet the residents, and see firsthand why so many discerning individuals choose to call it home.Schedule your private visit today by calling (239) 977-9744 or click here.
For Jeanne Findlater, moving to The Glenview at Pelican Bay wasnt just a change of address it was a discovery. I wish Id done it years ago, she said. I simply didnt realize what this lifestyle could offer.Jeanne knows a thing or two about recognizing exceptional opportunities. In 1979, she made history as the first woman in the country to lead a television station in a Top 10 market, when ABC appointed her Vice President and General Manager of WXYZ-TV in Detroit. Today, the Michigan Journalism Hall of Fame member, says one of the best decisions shes ever made was choosing The Glenview. I love having my own home and my privacy, Jeanne said. But I also love knowing that everything is taken care of. I dont worry about maintenance, repairs, or the little things anymore. Its incredibly freeing.The Freedom to Enjoy Every DayMost afternoons, Jeanne relaxes with a glass of wine, a mystery novel, and sweeping views of the Gulf before heading to dinner in The Glenviews elegant dining room. When shes ready to be social, all she has to do is open her front door. Its like living in a beautiful boutique hotel, Jeanne said. There are concerts, lectures, fitness classes, bridge, mahjongg, and wonderful people everywhere. It all comes together to create a very rich life.An Unmatched LocationFor Jeanne, The Glenviews location is equally extraordinary. Theres nothing else like it, she said. Were surrounded by the beauty of Pelican Bays protected mangroves, and I can take the complimentary tram to the beach whenever I want, enjoy lunch by the Gulf, then walk to waterside shops, the Artis Naples Performing Arts Center, or the Baker Museum. Everything is right here.A Home Thats Truly Her OwnJeanne also appreciates that residents own their homes, allowing her to create a space thats uniquely hers. I opened up my kitchen, added granite, and created a home thats perfect for entertaining, she said. It feels exactly the way I wanted it to.The Difference is the PeopleAbove all, Jeanne says its the people who make The Glenview exceptional. The staff is extraordinary, she said. Theyre caring, thoughtful, and always looking out for us. You feel supported every single day.Looking back, Jeanne has only one regret. I waited too long, she said. Life here is everything I hoped retirement could be.
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
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 34103Our 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
Hospice Care in Southwest Florida: Collier, Lee, Glades, and Hendry countyThe VITAS Healthcare team visits patients wherever they callhome, including but not limited to: private homes, senior living communities,and long term care facilities in Southwest Florida. We have offices located inCollier and Lee County and an Inpatient Unit in Naples. Coming soon, VITASInpatient Unit in Lee County.VITAS provides 24/7 support whenever our patients and familiesneed it.At VITAS, we prioritize our patients and their families aboveall else. By concentrating on enhancing quality of life, managing symptoms andpain effectively, and minimizing 911 calls and hospital readmissions, we ensureour patients' comfort and well-being. VITAS distinguishes itself fromtraditional hospice providers through a personalized approach to care planning,transparent medication management, and a comprehensive range of specializedmodalities tailored to meet diverse patient needs. These include physicaltherapy, occupational therapy, speech therapy, respiratory therapy, wound care,palliative oncology therapy, palliative dialysis, and more.Office Locations:Fort Myers VITAS HospiceOffice12751 Westlinks Dr. Fort Myers, 33913 Vitas Inpatient Unit atSolaris Healthcare Imperial900 Imperial Golf Course Blvd. Naples, 34110 Naples VITAS Hospice Office4980 N Tamiami Trail, Suite 102, Naples 34103Our Care ServicesAt VITAS we care for patients with an interdisciplinary teamcomprising a nurse, physician, aide, social worker and chaplain. Our teamsdesign 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