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UCD CalNorthstate

TITLE: Variation in Hospice Non-Core Services in Rural and Urban Communities 

Matthew Lee, MS4, California Northstate University, Elk Grove, CA

Sara Toulouie, MS2, California Northstate University, Elk Grove, CA

Aasim Naqvi, MS3, California Northstate University, Elk Grove, CA

Mariam Soni, MS3, California Northstate University, Elk Grove, CA

Quy Tran MD, University of California, Davis, Sacramento, CA


  • Identify potential variations in hospice non-core services in the State of California
  • Distinguish disparities in addressing hospice care needs in rural versus urban communities

Background: Variation in access to and quality of hospice services may be due to hospital revenue and resources. Medicare Conditions of Participation requires the provision of both core and non-core services to standardize hospice delivery. This study explores any variations in hospice non-core services across geographic factors. 

Methods: A retrospective analysis of the 2017 California Health and Human Services Home Health Agencies and Hospice Annual Utilization Report was conducted. Data on non-core services, defined as volunteer hours and number of visits from physical therapy, occupational therapy, homemaker services, and hospice aides, were extracted and correlated to hospice size (using revenue as a proxy) and hospice geographic service area (either primarily rural or urban). 

Results: Five hundred forty-one hospices (4% primarily rural) were included in the analysis. Average total operating revenue was $1.6 million for rural hospices and $18.4 million for urban hospices. Rural hospices reported on average 15 non-core visits and 13 volunteer hours per patient compared to 19 non-core visits and 9 volunteer hours per patient for urban hospices. 

Conclusion: No statistically significant correlation was found between hospice size or geographic region and volunteer hours or non-core visits. As rural hospices operate on smaller budgets and census sizes, they may compensate for fewer non-core visits with increased volunteer hours by relying more heavily on community philanthropy. Nevertheless, Bereaved Family Surveys continue to reflect overall high satisfaction with hospice services. Given their limited budgets, rural hospices should be recognized for providing high quality end-of-life care in geographically isolated communities.

POSTER CONTACT: Quy Nguyen-Hoang Tran;