Geographic Disparities in Hospice Availability: ZIP Code–Level Analysis of Organizational Presence and Service Provision in Two Midwestern States
Andrew Sheffield, Marcus Yoakam, Emily Hansen, Annabelle Hendrix, Ingrid JacobsonABSTRACT
Purpose
Rural populations face barriers to hospice care, and COVID‐19 disruptions to the hospice workforce and service delivery may have exacerbated these disparities, yet few studies examine geographic availability of hospice services post‐pandemic.
Methods
We examined hospice service availability across the rural−urban continuum in Kansas and Missouri using recent data to assess organizational presence and reported service provision across ZIP codes. Public‐use CMS data (August 2025 Hospice Provider and Hospice ZIP files) were merged with 2020 ZIP code‐level RUCA codes. Two hospice service measures were constructed: (1) hospice organizational presence, indicating a physical provider address, and (2) hospice service provision, indicating reported services to residents. Rurality was defined categorically as core metro, commuting urban, rural micropolitan, and rural noncore, based on RUCA codes. Frequencies and chi‐square tests assessed associations between hospice service availability and rurality.
Findings
Hospice organizational presence and service provision varied significantly by rurality in both states (all p <0.001). In Kansas, hospice organizations were in 7.5% of ZIP codes, most commonly in metropolitan areas (23%), followed by rural micropolitan (11%) and rural noncore (3%); none were in commuting urban ZIP codes. Despite this, hospice services were reported in over 80% of ZIP codes. Similar patterns were observed in Missouri, where hospice organizations were concentrated in metropolitan ZIP codes (18%) but services were reported in more than 75% of ZIP codes, including over 90% of rural communities. Although hospice organizations remain concentrated in metropolitan areas, services extend broadly across rural communities, likely through mobile or visiting care models.
Conclusions
These findings can inform resource allocation and strategies to improve equitable hospice access in underserved areas.