Factors affecting hospice social work utilization among hospice patients: Focusing on place of care and economic status

Objective. Hospice social workers empower their patients and families as they journey through end of life. However, even when social work services are available, some hospice families choose not to use or fully utilize this service. Guided by the Anderson behavioral model, this study examined factors affecting utilization of hospice social work services with particular focus on two enabling factors - place of care and economic status. Method. Data came from the 2007 National Home and Hospice Care Survey. The sample was restricted to Medicare Hospice Benefit enrollees 65 years of age and older. Hospice social work utilization was categorized into six visit intervals (0= none, 5= more than two visits in a week). Bivariate and ordinal logistic regressions were used to examine associations between hospice social work utilization and 1) place of care (home vs. institution) and 2) economic status (low vs. not low). Results. The frequencies of hospice social work utilization were found to be significantly different between place of care (χ2(1)=92.86, p<.001) and economic status (χ2(5)=11.28, p<.05). Even after controlling for predisposing and need factors in ordinal logistic regressions, hospice patients receiving care at home (Coef.=-.58, p<.001) and of low economic status (Coef.=-0.35, p<.001) were found to use social work services less frequently than their counterparts. Discussion. This study adds to the limited body of literature on enabling factors associated with hospice social work utilization. Possible implications and suggestions aimed at addressing these disparities are discussed.