by Agueda Pacheco Flores

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When Nathan Yemane’s father passed away two years ago, his father’s hospice experience wasn’t good enough. “Clinically it was competent, but culturally it was not,” he said. 

“They looked at his last name and didn’t think the family spoke good English,” said Yemane over a Zoom call. “I just want to point out there’s definitely cultural incompetence that occurred.”

Yemane would know. He has been a licensed independent medical social worker since 2013. During that time, he’s seen many of the ways racism manifests in the medical system. He remembers, for example, when white staff at a hospital made fun of a Black family that requested a Black nurse, going so far as saying the family was being racist for preferring a nurse from their own community. 

“When you think of end-of-life care and the life of a BIPOC participating in that medical system — what they deal with, what they’ve experienced within the medical systems, how they’ve been treated — there is a significant lack of trust,” Yemane said. 

It’s one of the reasons why Yemane wants to open King County’s first Black-owned hospice care service provider. 

He’s also inspired by his father, Yemane Berhan Gebremichael, who, before passing in 2020, had advocated for immigrants and youth for the past two decades. Gebremichael helped found Seattle’s Office of Immigrant and Refugee Affairs and advocated for raising the minimum wage in SeaTac, among many things.

Yemane named his business Y.B.G. Healthcare, in honor of his father and his legacy. But if and when he establishes the hospice service, he plans to do business under a different name, Heart ’n Soul. The Heart ’n Soul service provider is one of the only Black-owned hospice service providers in the country and has opened agencies in Tennessee and Michigan. Its office would be located in Renton, but staff would travel to clients wherever they are needed. 

Yemane says he feels strongly that equity needs to come from the top, therefore leadership needs to reflect the community it serves. Yemane has filled the position for hospice medical director with Dr. Carla Ainsworth, who is Black, is a physician, and has practiced medicine since 2004. She is also board-certified in family medicine, geriatric care, and hospice and palliative care. 

“It matters that patients feel like their health care team knows their community and their lived experiences,” Ainsworth said. “I think that this would allow us to connect some patients to hospice who had otherwise felt nervous or hesitant to do so.” 

After getting in touch with Heart ’n Soul owner David Turner via LinkedIn, Yemane says Turner became a mentor to him. 

“I saw the need here, and he had experience with running a Black-owned hospice,” Yemane said. 

Before Yemane can officially establish the state’s first Black-owned hospice agency, he must obtain a Certificate of Need approved by the state’s Department of Health (DOH), which regulates the number of facilities in the state based on need. The application process is not only expensive, costing $21,968, it’s also rigorous. 

According to King County data cited in Y.B.G.’s Certificate of Need application, Black patients are less likely to use hospice care. Yemane also found that Black people represent the demographic of the highest rates of hospice disenrollment. 

Y.B.G. submitted its application Dec. 30 of last year, but it’s competing with three other potential hospice agencies. Only two will be approved. 

No other pending application besides Y.B.G.’s application has a focus on providing culturally competent care to underserved communities. Before being approved, there also must be a public comment period, which has yet to be scheduled.

Yemane says the high-pressure application process itself creates barriers to entry and may explain, in part, why there are not more Black-owned medical businesses. He points to the fact that Washington State’s first Black-owned primary care clinic opened as recently as last year, in Shoreline. 

“When you look at Black-owned health care, they’re usually small businesses, and we’re having to compete against multibillion-dollar businesses,” Yemane said. “We are small fish.”

The South Seattle Emerald reached out to DOH for comment. A representative was not able to comment on Y.B.G. Healthcare’s application specifically, but did write via email that “all applications are assessed based on statutory and rule requirements.”

They added, “DOH is committed through the Certificate of Need process to ensuring equitable access to high-quality care across the state.”

In 2020, following global protests in response to the police killing of George Floyd, King County and Pierce County both declared racism a public health crisis. In the aftermath of the protests, the nation underwent a racial reckoning across industries, including the medical field. 

In Seattle, for example, Seattle Children’s Hospital saw prominent Dr. Ben Danielson, who led the Odessa Brown Children’s Clinic for 20 years, resign. Danielson was quoted saying, “The institution is replete with racism and a disregard for people who don’t look like them in leadership.”

Dr. Danielson wrote a letter of support as part of Y.B.G. Healthcare’s application to DOH.

While Y.B.G.’s hospice agency would serve everyone, not just People of Color, the organization itself would have an all-Black leadership and governing body. 

“If you have no representation, there’s always going to be some challenge to addressing the needs specific to BIPOC communities,” Yemane said.

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📸 Featured Image: Illustration by Jiéyì 杰意 Ludden.

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