Most States Do Not Provide Adequate Palliative Care, New Study Finds

Most states do not provide adequate end-of-life care to patients with terminal illnesses, according to a state-by-state report on palliative care issues, the Atlanta Journal-Constitution reports. Last Acts, a coalition of more than 1,000 health care and advocacy groups, such as the American Medical Association, the American Nurses Association, the American Hospital Association and the Robert Wood Johnson Foundation, sponsored the report. In the report, titled "Means to a Better End: A Report on Dying in America Today," states received grades from A to E, with A as the highest score, in eight categories (Guthrie, Atlanta Journal-Constitution, 11/19). The report graded states on the quality of their end-of-life policy; where their residents die; their rate of hospice use; end-of-life care provided in their hospitals; end-of-life care provided in their ICUs; the persistence of pain among their nursing home residents; their policy on pain management; and the number of their physicians and nurses certified in palliative care (Last Acts release, 11/18). Most states received Cs, Ds and Es in most categories, the Detroit Free-Press reports (Anstett, Detroit Free-Press, 11/19).

The report did not provide overall grades for states but outlined several "problems and gaps" in end-of-life care nationwide, the Newport News Daily Press reports (Newport News Daily Press, 11/18). The report found that Alabama, Louisiana, Mississippi, New Mexico, North Carolina and South Carolina reported the longest hospice stays in 2001, with a median stay of between 30 and 45 days; the report said that patients must participate in hospice care for 60 days to receive the "maximum benefit," AP/Long Island Newsday reports. In addition, although enrollment in hospice care nationwide increased from 1,000 patients in 1975 to 700,000 in 2000, the report found that patients enroll "ever closer to the time of death." Patients spent an average 70 days in hospice care in 1983, but the average decreased to 36 days by the mid-1990s; in 1998, about 30% of hospice patients enrolled less than a week before they died, the report found (AP/Long Island Newsday, 11/18). In addition, more than 70% of U.S. residents would prefer to die at home, but only about 25% die at home, the report found. According to the report, half of deaths in the United States occur in hospitals, but most facilities do not provide adequate end-of-life care. Fewer than 60% of hospitals nationwide offer specialized end-of-life care; 23% of hospitals offer hospice care, and 42% offer pain management services, the report found (Reuters/Newark Star-Ledger, 11/19). The complete report is available online. An NPR "Morning Edition" report on the report will be available online in RealPlayer after noon ET online. In addition, extended NPR coverage is available online.

A separate survey released yesterday by Last Acts found that a "significant number" of U.S. residents are "dissatisfied" with palliative care provided by the nation's health care system. The survey of 1,002 U.S. adults, conducted between Aug. 30 and Sept. 1, found that 60% rate the nation's health system "fair or lower"; 25% rate the system "poor," and 10% rate the system "very good or excellent." About 75% of survey respondents rate the U.S. health care system "fair or lower on assuring that families' savings are not depleted by end-of-life care," the survey found. In addition, about 46% of survey respondents said that the nation's health care system does "only fair or poor job" in the provision of emotional support to patients with terminal illness and their families, the survey found (Last Acts release, 11/18).