Neighborhood Immigrant Density and Quality of Patient Experiences with Hospice Services

Background and Purpose: Although hospice care has been described as the gold standard for terminally-ill patients, an established body of research has described minorities’ underrepresentation in hospice in the U.S. Research also documents the impact of location of services (e.g., rural vs. urban) on Black-white differences in quality and quantity of services. The impact of neighborhood structural characteristics on quality of services available (patient satisfaction with agency services), however, has not received as much attention. To help address this gap, this study explored the relationship between neighborhood structural characteristics and hospice agency quality based on patient-reported satisfaction with agency services.

Methods: We examined the relationships between neighborhood structural characteristics and family ratings of satisfaction with hospice as reported in the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey. CAHPS is administered to families or caregivers following the patient’s death to assess their experiences with care for the purposes of assessing provider performance and is reported at the agency level. The sample included data from 2017-2019 from 42 Florida hospices (of 46 total agencies in the state) reporting CAHPS data. The dependent variables examined were percentage of the answers for each hospice indicating satisfaction with categories of always/usually, and included: (1) provided timely care, (2) communicated well, (3) met spiritual needs, and (4) whether or not patients would recommend the agency. Independent variables were neighborhood structural characteristics measured through using two constructs—neighborhood immigrant density (percentage of foreign-born based on U.S. Census), and Neighborhood Concentrated Disadvantage Index (CDI; formed based on Phenx Protocol with 6 variables from U.S. Census data). ArcGIS software was used to generate heatmaps to provide visual representations of the relationships through mapping.

Results: Findings showed statistically significant inverse correlations between the variables included in the model. Neighborhood immigrant density significantly predicted family satisfaction with timely care F(2, 39) = 2.72, p <.05, communication F(2, 39) = 5.31, p <.01, spiritual support F(2, 39) = 15.06, p <.001, and likelihood to recommend the agency services F(2,39) = 7.14, p <.001. The statistically significant negative correlations indicate that family satisfaction with timely care (B= -.07, p <.05) communication (B= -.07, p <.01) and spiritual support (B= -.16, p <.01), and likelihood to recommend the agency (B= -.10, p <.01) all decreased as neighborhood immigrant density increased. Concentrated neighborhood disadvantage was not associated with any of the family satisfaction variables.

Conclusions & Implications: We found support for the role of neighborhood context (i.e., immigrant density) in predicting agency rating of consumer satisfaction with services. Specifically, the greater the immigrant density of a neighborhood, the lower the rating of satisfaction with services based on CAHPS measures. Given that the older adult population is growing in numbers and in diversity, further research is warranted to understand factors shaping services and care experiences of patients from neighborhoods with high concentrations of immigrants. Identifying mutable factors that offer opportunities for interventions to increase the quality of services available to minority populations in their communities remains a need.