Sunday, April 27, 2014

Urban Palliative Care: Low-Income Communities (Research)

I have spent my entire adult life working in urban, low-income communities. With a 96% poverty level, my school where I was principal in Detroit had more homeless students than any school in Michigan. If you are working to deliver palliative care to inner-city patients and caregivers in these communities, you must become knowledgeable about the social and economic barriers that can hinder their access to quality palliative care. 

A healthcare focus group consisting of community stakeholders including healthcare professionals, persons living with chronic illnesses, and caregivers in five inner-city communities reported these five themes:

1)   Lack of family support
2)   Communication barriers with healthcare professionals
3)   Stresses of being a person of color or another minority
4)   Caregiver burdens
5)   Lack of spiritual support

Community outreach is mandatory for reaching this population. Also needed are cultural sensitivity, available resources, and services to improve access to care. Low-income populations with chronic illnesses in urban communities are entitled to quality of life just like everyone else. This isn’t only a healthcare issue. It’s a moral one.

Frances Shani Parker, Author
Becoming Dead Right: A Hospice Volunteer in Urban Nursing Homes is available in paperback and e-book editions in America and other countries at online and offline booksellers.
Hospice and Nursing Homes Blog


  1. I agree completely with this article. I find the most common barrier for hospice to a general mistrust in the urban population; and with good reason! Only through education of the inner city populations on a consistent basis will the first threads of trust be established.

  2. John, thank you for responding. The responsibility for changing the general mistrust many urban populations, particularly people of color, have regarding the healthcare system lies with the healthcare system that created the mistrust. You are correct when you say, "And with good reason!" And it doesn't require a search into the historic past to find numerous reasons. Current health disparities and inequalities reported by the CDC Health Disparities & Inequalities Report (CHDIR) speak for themselves.

    The whole nation is impacted by these injustices. Reducing disparities requires national leadership to engage a diverse array of stakeholders; facilitate coordination and alignment among federal departments, agencies, offices, and nonfederal partners; champion the implementation of effective policies and programs; and ENSURE ACCOUNTABILITY.

    The "healthcare system" includes everyone who works in it, not just those in the highest paid positions. Everyone has the responsibility of treating patients equally with quality care. It's a moral issue.

  3. Trudy EganApril 27, 2014

    Frances, you cite caregiver burden as a factor detracting from palliative care for the poor. In California, where I live, MediCal (medicaid) pays for a few hours a day of home care, or covers custodial care in a SNF at 100%. That means that working families are forced to place their dying relatives in a SNF because the few hours of paid caregiving are not enough time to go out and earn a living. I find this especially sad because the day rate for a SNF and for a 24/7 paid caregiver are quite similar.

  4. Thanks for sharing that example, Trudy.