Program Evaluation for Bereavement Services at Tender Love Hospice

Program Evaluation for Bereavement Services at Tender Love Hospice

Tender Love is a for-profit organization that is entrusted to provide end-of-life care to more patients in South Texas than any other hospice. For those experiencing a life-limiting illness or injury we are here to assist in all your family needs. Tender Love offer compassionate care leads to the innovation that is setting the standards for the future of hospice and is committed to quality patient care, caregiver support and education through psychosocial, and bereavement supports.

Tender Love accepts Medicaid, Medicare, most private insurance, TriCare, and private pay.

Tender Love is the leading hospice provider in the region. With Hispanics being the fastest growing minority in the United States, numbering over 42 million and comprising 15% of the total population (U.S. Census Bureau, 2008). Hispanics are a heterogeneous group that experience disparities in accessing health care, including at the end of life. With this number continuing to grow we are focusing on our most served population by working on ways to meet our people's needs.

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To ensure we are bridging the gaps between socioeconomic status, level of education, language barrier, accessibility to services and healthcare; we have a team ready to assist with issues our Hispanic population may be facing. We ensure our team has two to three social workers who are bilingual.

From our survey conducted we evaluated patients and their families feel more comfortable communicating with personnel who are bilingual vs. using interpreting services. Hospice bereavement coordinators indicated that limited services were available specifically for Spanish-speakers and that language and cultural barriers were challenges when communicating, offering, and delivering bereavement services to Hispanics (Arriaza, Martin & Csikai, 2011).

This also allows Tender Love to build the rapport with families and develop the connection to trust that we will take care of them and their families. Building rapport is important in finding common ground and being empathic.

At Tender Care we most often see that one of the biggest concerns with our Hispanic population is being uninsured. Although many residents are eligible for government-funded healthcare services, there are numerous who are uninsured.Many times, we find it has been issued of Hispanics not knowing how to apply, submit correct documentation for approval, not following up etc. We have a Presumptive Eligibility worker and they assist any of our patients with a Medicaid On-Site Application, they tell patients and families of items they will need to get approved and will assist until the approval process is complete. With Medicaid managed care it helps preserving hospice funding, providing incentive payments for health care improvements and directing more funding to hospitals serving large numbers of uninsured patients, all with the aim of improving health services and reducing uncompensated care.

With these efforts we are seeing results. According to article on uninsured healthcare decreasing it indicates across key subgroups, Hispanics have experienced the largest declines in their uninsured rates since the fourth quarter of 2013. The rate among Hispanics was 28.3% in the first quarter of 2016, still significantly higher than for all U.S. adults, but down 10.4 points from the fourth quarter of 2013. These larger declines for Hispanics partly reflect higher uninsured rates among those demographic groups relative to whites with past years (Marken,2018).

As Tender Love continue to thrive in meeting the needs of our Hispanic population, we address one of the hardest parts of working in the healthcare field; which is overcoming language/cultural barriers. In 2015, the U.S. Census Bureau recorded a population of 27.45 million in Texas (US Census Bureau, 2016). Of this 27.45 million, 65% speak only English at home. The most common non-English language spoken in Texas is Spanish with almost 7 million Spanish speakers recorded in 2015 (Ura & McCullough, 2015). As seen in the image to the left, 24.9% of Austin households speak Spanish. For a state with the second highest number of Spanish speakers, Texas still cannot provide the same quality of care to its minority and non-English speaking population as it does to its white, English speaking counterpart.

According to reports from the United States Census Bureau (2017) Texas continues to be home to some of the poorest counties in the country with poverty most prevalent along the Texas-Mexico border, census figures show. The latest county-level poverty estimates from the U.S. Census Bureau, released in December, show that poverty is disproportionately distributed across the state. Among counties with at least 10,000 residents, border counties face the highest rates of residents living in poverty, nearly one in three people in South Texas. Meanwhile, suburban counties near the state's largest cities contain the smallest shares of poor people, with less than 10 percent of residents living in poverty in many suburbs (Ura,2016).

Barriers to educational advancement experienced by Hispanic in the United States, including entering school at a disadvantage because of a lack of exposure to literacy activities at home and in early formalized school settings, teacher assessments of students' language proficiency influencing instructional practices, lack of guidance of future opportunities (Schhneider, Martinez, & Ownes, 2019). With many other issues Hispanics dealing with, sometimes education is not a priority. Many Hispanics don't complete their high school education and continuing education chances have decreased. Our staff is trained to provide resources for all.

At Tender Love we want to make sure we are addressing all the needs of our patients and families. We continue to provide continued education training for our staff for one of the two most perceived challenges in bereavement services. Some of the trainings include Cultural competence training for health care professionals, trainings focus on skills and knowledge to value diversity, understand and respond to cultural differences, and increase awareness of providers and care organization's cultural norms. Trainings can provide more complex interventions such as intercultural communication skills training, exploration of potential barriers to care, and institution of policies that are sensitive to the needs of patient (Arriaza, Martin & Csikai, 2011).

Grieving the loss of a loved one can take a toll on all parties involved. Therefore, Tender Love has bereavement support group called 'Life After Loss' over the past several years, efforts to aid the bereaved have increasingly focused on the physical, psychological, spiritual suffering and social isolation associated with bereavement. Resulting in intervention options, ranging from mutual-help support groups, pharmacotherapy and professionally led psychotherapy These services in bereavement care can be found at Life After Loss which provide an array of bereavement care interventions focusing on our goal of decreasing the severity of bereavement-related symptoms.

References

Arriaza, P. M. (2011). An assessment of hospice bereavement programs for Hispanics. Journal of Social Work in End-of-Life & Palliative Care

Marken, S. (2018, October 22). U.S. Uninsured Rate at 11.0%, Lowest in Eight-Year Trend. Retrieved from

Schneider, B., Martinez, S., & Ownes, A. (2019). Barriers to Educational Opportunities for

Hispanics in the United States. Retrieved from A. (2016, January 19).

Latest Census Data Shows Poverty Rate Highest at Border, Lowest in Suburbs. Retrieved from