Mahogany Diversifies with New Palliative, Nonskilled Home Care Service Lines

Ohio-based Mahogany Home Health and Hospice has unveiled two new service lines — palliative and nonskilled home care — to improve equitable, inclusive access among seriously ill patient populations.

The hospice and home health provider recently began to provide palliative care and nonskilled home services. Diversifying into these two new realms came with the organization’s recent certification of age-friendly services and Community Health Accreditation Partner (CHAP) accreditation.

Developing strong referral and community relationships was an important part of understanding the types of services that would be most beneficial in helping to reduce disparities, said Victor Couzens, owner, founder and CEO of Mahogany Home Health and Hospice. A main goal of the service diversification efforts is to provide better care continuity, he stated.

“Our goal is to try to bridge the gaps in care, particularly for underserved populations,” Couzens told Hospice News. “Because we know in underserved communities, those gaps are just so huge among the continuity of care. We want to try to bring as many things to as many people as possible by offering culturally sensitive and community-rooted services that meet patients and families where they are physically, spiritually, emotionally and psychosocially.”

Mahogany’s new palliative care program provides pain and symptom management, and also addresses patients’ psychosocial, spiritual and emotional needs. Its novel nonskilled home care program provides assistance with activities of daily living (ADLs), personal care, psychosocial assessments and goals-of-care discussions.

Underserved communities often receive limited education about their health care options as a chronic condition progresses, according to Couzens. Among the multifaceted issues is a lack of culturally-sensitive and informed programs that are responsive to patient and caregiver needs, he stated.

Adding palliative and nonskilled home care to its service repertoire will help form stronger referral relationships with larger health and hospital systems, Couzens indicated. A driving force of these two new services is to break down barriers of mistrust and misconception among diverse patient populations.

“Oftentimes, these people don’t know how to navigate from one service line to the next,” Couzens said. “You could be on palliative care and be receiving nonskilled home care. We have an opportunity to build relationships and build trust particularly through these services. We want to get to the point where we are actually normalizing culturally-affirming care that is really community-based and centered.”

Mahogany Home Health and Hospice provides care in Cincinnati and Dayton, Ohio, and surrounding communities. The startup launched services earlier this year, becoming the state’s first Black-owned hospice and home health organization. The organization aims to improve utilization among underserved populations.

White Medicare decedents represent the majority of patients who utilize hospice, reaching a rate of 86% in 2024, according to the Hospice Care Charterbook report from the Research Institute for Home Care and KNG Health Consulting LLC. Hospice utilization among other groups has remained low since the establishment of the Medicare Hospice Benefit, with rates at 8.2% among Black decedents, as well as Hispanic, Asian and North American Natives, at 1.8%, 1.4% and 0.4%, respectively, the report found.

Demand for “truly culturally intelligent care” is swelling at unprecedented rates, Couzens said. More hospices need to delve deeper into community-based settings to understand the root causes impeding greater access among underserved groups, he stated. Stronger home-based support will go a long way toward improvement.

“There’s a huge demographic of people that we are missing and have an opportunity to provide services and support for, because with hospice our narrow focus can be where we get our referrals from,” he told Hospice News. “Our approach is a lot of community outreach and providing additional training with other providers to understand the cultural values around illness, death and caregiving. The representation matters. The future is going to be home-based, person-centered care. We’re going to see more providers with this kind of hybrid trifecta of home health, hospice and palliative to have earlier interventions.”

Greater palliative care payment streams are needed to support a swelling and diverse aging population, according to Couzens. Current reimbursement in this arena does not sufficiently support demand or the full scope of interdisciplinary services. However, payment frameworks exist that could lay the groundwork for a stronger foundation, he indicated.

The most challenging aspect of launching a new palliative care service line is navigating a complex reimbursement system, Couzens indicated. Mahogany Home Health and Hospice is currently transitioning its electronic medical record system to integrate billing capacity for nonskilled home and palliative care services.

“If we had a way where we could build out the service intensity add-on, sort of like we do with continuous hospice care that we’re already providing, that would help,” Couzens said. “Because then we could pay a better living wage and invest more in palliative staff development and training. That would give people a better opportunity to receive services and support they need.”