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Hospice Utilization among American Indians in California and Arizona

Hospice Utilization among American Indians in California and Arizona. Kyusuk Chung, Ph.D and Ann Jaso , MHA California State University at Northridge and Governors State University . Indian Health Care Improvement Act of 1992 as Amended in Oct. 2000.

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Hospice Utilization among American Indians in California and Arizona

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  1. Hospice Utilization among American Indians in California and Arizona KyusukChung, Ph.Dand Ann Jaso, MHA California State University at Northridge and Governors State University

  2. Indian Health Care Improvement Act of 1992as Amended in Oct. 2000 • Called for Hospice Feasibility Study (section 205) • (1) to assess the feasibility and desirability of furnishing hospice care to terminally ill Indians; and • (2) to determine the most efficient and effective means of furnishing such care. • Not later than the date which is 12 months after October 29, 1992, the Secretary shall transmit to the Congress a report containing— • (1) a detailed description of the study conducted pursuant to this section; and • (2) a discussion of the findings and conclusions of such study.

  3. The Study Should Address: • (1) assess the impact of Indian culture and beliefs concerning death and dying on the provision of hospice care to Indians; • (2) estimate the number of Indians for whom hospice care may be appropriate and determine the geographic distribution of such individuals; • (3) determine the most appropriate means to facilitate the participation of Indian tribes and tribal organizations in providing hospice care; • (4) identify and evaluate various means for providing hospice care, including—(A) the provision of such care by the personnel of a Indian Health Service hospital pursuant to a hospice program established by the Secretary at such hospital; and (B) the provision of such care by a community-based hospice program under contract to the Service; and • (5) identify and assess any difficulties in furnishing such care and the actions needed to resolve such difficulties.

  4. Palliative Care: An Emerging Issue for American Indians and Alaskan Natives by J.A. Kitzes* • Since 1999, efforts at addressing the growing palliative care needs of American Indian and Alaskan Native communities have emerged. Not until 1999, Palliative care has been formally addressed for these communities. • The number of palliative care programs in place or being planned in tribal and IHS sites is not known because there is no central reporting for these programs. • the first national IHS conference on end-of-life care in 2001 • the first IHS National Palliative Care Training conference in 2002

  5. Palliative Programs Examined by Dr. Kitzes • Navajo Reservationat Fort Defiance, Arizona: The IHS office was planning a full hospice program. • Zuni, New Mexico: a tribally-operated home health agency provides home-based hospice care • Anchorage, Alaska: A home health agency established for tribes provides palliative care. • The IHS program at Cherokee, North Carolina has developed a contractual relationship with the two hospice programs in the area. • *Kitzes, J.A., & T. Domer. 2003.“Palliative Care: An Emerging Issue for American Indians and Alaskan Natives.” Journal of Pain and Palliative Care Pharmacotherapy, 17(3/4): 201-210

  6. Our Study Purpose • Examined Hospice utilization rate (# hospice deaths divided by # deaths) among American Indians in California and Arizona • 2010 Census Data • American Indian/Alaska Natives 65 and older (One race alone) • California: 29,438 • Arizona: 20,023 • Chose Arizona because American Indians concentrate. • Chose California because many American Indians live but without concentration.

  7. Data Used • CDC’s mortality data of 2010 by race and county • Arizona Hospice Utilization Data for 2010 • # Patients served by race • Hospice Service Area (County level) • California Hospice Utilization Data for 2010 • # Unduplicated hospice patients by race • # of Patients Served by County of patient’s residence at time of admission

  8. Measures • Dominant versus Non-Dominant American Indian (AI) Counties: • Based on Share of AI population as the percent of Total County population • AI-Dominant Counties, Arizona: If the share of NA population exceeds 8% of the county total population • AI-Dominant Counties, California: If the share exceeds 4% • Hospice Utilization Rate: IA-Dominant versus Non-dominant • # Hospice Deaths / # Deaths

  9. The Share of Native Americans as Percent of Total Population Twelve Native American Counties, California Seven Native American Counties, Arizona

  10. Share of Native Americans as Percent of Total Population

  11. Share of Native Americans as Percent of Total Population

  12. Comparing Hospice Use: AI versus Non-AI areas • Hospice Utilization Rate in AI group of counties • # of AI deaths aggregated at AI group of counties • # of AI deaths under hospice care aggregated at AI group • Hospice Utilization Rate in Non-AI group of counties • # of AI deaths aggregated at Non-AI group of counties • # of AI deaths under hospice care aggregated at Non-AI group of counties

  13. Qualitative Analysis • Explored the level of awareness of hospice care among American Indian caregivers of the Great Lakes Region • We interviewed 25 tribal members of the Great Lakes Region, with 15 residing on reservation lands and 10 residing in metropolitan areas. • Conducted the study from March 2011 through December 2011 • Domains and Questions • Awareness of hospice service on a 5-scale • Perception of significance/helpfulness of hospice service • Knowledge about Hospice Core Services • Cultural beliefs and practices concerning death and the dying process

  14. Great Lakes Region in Wisconsin

  15. Findings I • A majority of interviewees were aware of hospice • Our interviews confirmed our quantitative findings: Great Lakes tribal members residing on reservations reported that no hospice care was available to reservation residents. • Interviewees living on reservations were more likely than those living in metropolitan areas to emphasize the importance of the provision of hospice care respecting Indian culture and beliefs concerning the dying process.

  16. Findings II • Training tribal members to deliver hospice services • they feel more comfortable with members of their own tribe • Their religious values are regionally diverse • Many urban Indians believe differently when off the reservation, however return to the reservation during the death process.  • Grief counseling, before and after death, was asked for and was desperately needed. 

  17. Concluding Thoughts: Hospice Model for the tribes • Determine the most efficient and effective means of furnishing such care. • identify and evaluate various means for providing hospice care • Agencies or Offices serving residents of Cherokee, NC* • Cherokee Good Shepherd Home Health and Hospice Agency, Inc. 71 Admissions; 60 deaths • Cherokee Community Home Care and Hospice 11 Admissions; 5 deaths • Currently no inpatient beds available; # deaths and hospice use are not large enough to support an hospice inpatient facility • No licensed Agencies or Offices serving residents of Apache, AZ • NC regulates hospice industry by certificate of need, while AZ does not. • Some tribes are not large to warrant a hospice agency, nor would they want one.

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