Despite the proven benefits of hospice and palliative care, Native Americans have historically underutilized these services. Palliative care provides individuals with serious illnesses and their families with care and support and can extend lifespan and quality of life once individuals choose to stop curative treatments. Hospice is limited to individuals with 6 months or less to live. Both are Medicare-eligible benefits, and can manage and reduce symptoms of illness and reduce hospital admissions and readmissions. 

Although research and data are limited, an NHPCO report found that of those who use hospice, 0.4% were from the American Indian/Alaskan Native community, while 82% were white. An article in Transcultural Nursing found four themes surrounding the lack of palliative care in Native American communities: communication, cultural awareness and sensitivity, community guidance for palliative and hospice care programs, and barriers. 

• Communication refers to language preferences, non-verbal cues and other culturally-specific communication styles, like collectivist decision-making. 
• Cultural awareness and sensitivity is taking into account the uniqueness of Indigenous individuals and communities and the ways they receive and perceive healthcare. 
• Community guidance for palliative care and hospice programs refers to the need for input from Indigenous communities when creating these programs. 
• Barriers can include insurance coverage, geographic region and rurality, discrimination and poor funding. 

There is a movement to improve cultural competence in palliative care and ensure that everyone has access to this option if they are seriously ill. Compassion & Choices recently granted researchers in Eureka, California funding to create a video series on this topic. The videos interview two Native American women, their families and their communities. These videos will help medical providers and other stakeholders understand what these communities need and what their values are as they navigate living and dying as a community. 

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