Heart and Soul Hospice aims to provide end-of-life care and grief support to all Nashville area residents. But as a Black-owned business, it is especially focused on meeting the palliative care needs of an underserved minority community: African Americans.

African Americans make up 27% of Nashville’s population but only 19% of hospice patients, according to a Kaiser Health News profile on Black hospice care. What’s more, despite the proliferation of hospice agencies in the city, Heart and Soul Hospice was granted a permit because regulators recognized the need to educate the Black community about hospices and provide those services.

The situation isn’t unique to Nashville. Mirroring other measures of health equity that reflect racial disparities, national statistics show that compared with white Medicaid recipients, fewer Black Medicaid beneficiaries who died in 2019 took advantage of hospice care (41% compared with 54%). This is a telling statistic, Kaiser Health News notes, because hospice services are usually paid for by Medicaid, Medicare and most private health insurance, so cost is not the main issue. Besides, hospice care is often much more affordable than a hospital stay.

“Just as you are entitled to unemployment, as you are entitled to Social Security, you are entitled to a hospice benefit,” Keisha Mason, a nursing director who helped launch Heart and Soul Hospice told Kaiser.

Why don’t more Black Americans seek hospice services when a loved one approaches the end of their life? It’s complicated. Experts point to the Black community’s mistrust of the medical establishment and to specific cultural and spiritual beliefs—and to the fact that in most cases African Americans don’t see themselves reflected in the staff of hospice agencies.

The National Hospice and Palliative Care Organization has published a guide to better explain the situation and offer strategies for reaching out to African-American communities. Among several findings it references, the guide notes that Black Americans consider health issues to be personal and private journeys—not an opportunity to literally invite strangers into your home.

However, celebrities and local faith leaders can help influence views about health and illness. For example, the unexpected death of actor Chadwick Boseman (Black Panther) of colorectal cancer gave health and hospice providers a context for reaching out to the community. (Heart disease and cancer were the two leading causes of death among African American adults in 2017, the guide notes. They’re followed by stroke, diabetes, Alzheimer’s disease and chronic lower respiratory disease, such as bronchitis, emphysema and asthma.)

The hospice care guide lays out these eight tips for reaching out to the African-American community, with detailed suggestions for each:

  • Get organized;
  • Listen to your community;
  • Let your message be heard;
  • Consider marketing;
  • Build partnerships;
  • Embrace the faith community;
  • Participate in and host community events;
  • Connect with African-American media.

“By investing in community health outreach programs,” notes the report, “hospice and palliative care organizations can become preferred providers and known for quality in Black/African-American communities.”

In related news, see the Cancer Health article “Black Patients Are More Likely to Die of Cancer—Here’s How One Group Is Tackling That.”