Hospice, Dying and Death

Mrs. D

The act of dying and death has been a more naturally accepted process culturally in the Hispanic/Latino communities than other communities (Talamantes, Gomez, Braun, 2000). Religion, faith and spirituality hold an important role in the acceptance of death (Villa, 1991).

El Dia de los Muertos

El Dia de Los Muertos (Day of the Dead) is a holiday celebrated throughout Mexico and in Hispanic communities in the southwestern part of the United States. During El Dia de Los Muertos, families go to the gravesites of deceased family members and take food and other symbols in order to honor the lives and to celebrate the unity of the family. Additionally, decorated altars depicting pictures of the deceased and symbols representing death and dying and important mementos for the family members can be displayed in numerous places during this holiday. In discussing dying and death, Hispanic/Latino elders often incorporate “dichos” or sayings about God and their faith (Talamantes, Gomez, & Braun, 2000).

Use of Hospice

In contrast, although death appears to be more readily accepted by Hispanic/Latino elders, the use of Hospice services tends to be significantly lower for this elder group as reported by several studies (Talamantes, Lawler, Espino, 1995; Pawling-Kaplan & O’Connor, 1989). Reasons for not utilizing Hospice services included lack of knowledge about Hospice programs, the use of Hospice services would denote “giving up hope and faith” in the life of the dying patient, lack of insurance, and distrust in the provider or health care system (Talamantes, Gomez, & Braun, 2000; Morrison, et. al., 1998).

It is evident in the literature that Hispanic/Latino elders do not make end-of-life decisions autonomously, rather, decisions are made in a familial context usually with reliance on the physician for guidance (Romero et al., 1997; Talamantes & Gomez, 1996; Blackhall, et al., 1995, Murphy, et.al., 1996).

Recommendations to providers for patient and family discussions on end-of-life decision making include the following:

  • Assess the patient and family (when applicable) for understanding of end-of life issues and values associated with making health care decisions
  • Become knowledgeable about the elder’s cultural background; including social-historical, religion and spirituality and health belief system
  • Recognize language issues and screen for barriers of service use
  • Utilize values history (a document to process decisions and values related to medical care) as a guide for provider and a method for Hispanic/Latino elders and families to begin to think about end-of-life issues (McIver-Gibson, 1990)
  • Conduct grass root outreach efforts to discuss end-of-life issues
  • Recruit bilingual/bicultural volunteers in Hospice and Palliative care programs.