How some states fared: Lousy to above average
Most don’t meet organization’s overall standards
Even states that ranked high in hospice use earned low grades overall on a national report card prepared by the Last Acts organization in Washington, DC.
Arizona, for example, scored the highest in hospice use, but did not meet Last Acts’ overall standards. The state scored well in providing palliative care and having trained personnel in palliative care. The state’s policies regarding advance directives were also found to be strong. On the downside, many Arizona hospitals do not have palliative care or hospice programs, and the state’s nursing homes do only a fair job of managing persistent pain among the dying. According to the report, Arizona’s findings indicate that the state needs to do more to prepare for the needs of the frail elderly and the dying, both now and in the future, when the number of Americans over the age of 65 will be rapidly increasing.
Here is how the state scored on each of the report’s criteria:
• Hospice use — With 42% of residents over 65 who died in Arizona using hospice care in the last year of their lives, Arizona topped all other states in this measure. Nevertheless, this earned the state a B grade, because even this high number falls short of Last Acts’ expectations for hospice use. In an evaluation of the number of days spent in hospice, Arizona earned a D grade. The median length of stay in hospice in Arizona was close to 28 days, which is well below the 60 days considered necessary for maximum benefit from hospice. (Click here to see chart.)
• Palliative care-certified physicians and nurses — The state received B grades for the number of physicians and nurses trained to provide palliative care, suggesting that Arizona’s health care work force is preparing better than those of other states for current and future needs of the frail elderly and dying, the report says.
• State advance directive policies — Arizona’s policies earned a B grade. This means they support good advance care planning in the form of living wills and medical powers of attorney, which designate a health care decision-maker should the patient become unable to communicate.
• Pain among nursing home residents — Nursing homes in Arizona do a poor job of managing patients’ pain, earning a D grade from Last Acts. Forty-seven percent of nursing home residents were found to be in persistent pain. Experts agree that 90% to 95% of pain can be successfully managed.
• Hospital end-of-life care services — Arizona’s hospitals offer average to poor end-of-life care services. Forty-six percent of hospitals reported offering pain management programs, rating a C grade. However, far fewer hospitals said they offer hospice or palliative care programs.
• Location of death — Only 26% of Arizona residents die at home, although most Americans say they prefer to die at home in comfortable surroundings with their loved ones. The state earned a D grade in this category.
How New Mexico fared
New Mexico is among a group of states that scored better than most in hospice use, but earned scattered marks. On one hand, the state’s policies regarding advance directives were rated highly. New Mexico also had a high percentage of physicians and nurses who are trained to provide palliative care. On the other hand, many New Mexico hospitals do not offer hospice or palliative care programs. The state’s nursing homes also do a poor job of managing the pain of the dying. These and other findings indicate that the state needs to do more to prepare for the needs of the frail elderly and dying.
Key findings on the status of end-of-life care in New Mexico include:
• State advance directive policies — New Mexico’s state advance directive policies earned an A grade, because they support good advance care planning in the form of living wills and medical powers of attorney.
• Palliative care-certified physicians and nurses — The state received the highest grade of A for the percentage of physicians trained to provide palliative care, and a B grade for the percentage of nurses trained in the same field. This suggests that the health care work force is doing a good job in preparing for current and future needs of the frail elderly and dying.
• Hospital end-of-life care services — A majority of hospitals in New Mexico do not offer hospice and palliative care services. The state earned the lowest possible grade — an E — for the small percentage of hospitals reporting hospice programs (20%) and the small percentage of hospitals reporting palliative care programs (15%). New Mexico also earned a D grade from Last Acts for its 24% of hospitals self-reporting pain management programs.
• Pain among nursing home residents — Nursing homes in New Mexico do a poor job of managing patients’ pain, earning a D grade from Last Acts. Forty-five percent of nursing home residents indicated that they are in persistent pain.
• Hospice use — Even though hospice is the most commonly available form of palliative care, only 30 percent of people over age 65 who died in New Mexico used hospice in the last year of life. Moreover, the average length of hospice care in the state was 35 days, which is less than the 60 days considered necessary for the maximum benefit from the program.
• Location of death — New Mexico earned a C in this category because a majority of the state’s residents do not die at home, although most Americans say they prefer to be at home in comfortable surroundings with their loved ones.
While no state scored an A for hospice use, three states — Rhode Island, Maine, and Alaska — were singled out as failures in making hospice available to its residents. All were given the lowest grade, an E.
In Rhode Island, state policies encourage good pain management for the terminally ill, but the state fared poorly in a number of measures of hospice use. Hospice use is low, and few residents die at home, the report notes. Few hospitals in the state offer hospice or palliative care programs. The state also has very few physicians trained to provide palliative care. These and other findings indicate that the state is not well-prepared to provide for the needs of the frail elderly and dying.
Key findings on the status of end-of-life care in Rhode Island include:
• State pain policies — Rhode Island state policies regarding pain management earned a B grade from Last Acts, because they allow physicians to treat pain at the end of life without undue scrutiny.
• Hospice use — Hospice care is not widely used in Rhode Island. Even though hospice is the most commonly available form of palliative care nationwide, only 18% of people over age 65 who died in Rhode Island used hospice in the last year of life. Moreover, the median length of hospice care in the state was 14 days, well below the 60 days considered necessary for the maximum benefit from the program.
• Hospital end-of-life care services — Very few hospitals in the state (6%) report offering hospice or palliative care programs, earning the lowest possible grade — an E — from Last Acts.
• Location of death — Only one-fifth of state residents die at home. The state earned a D grade from Last Acts on this measure.
• Palliative care-certified physicians and nurses — The state’s health care work force needs to be better prepared to meet the current and future needs of the aging and dying. The number of registered nurses trained in palliative care earned the state a C grade. However, the number of physicians with such training earned Rhode Island a grade of E.
Maine is another state that seemed to score poorly in most aspects of end-of-life care, including hospice use. Maine’s policies regarding advance directives were strong, and the state’s policies allow physicians to treat pain at the end of life without undue scrutiny. Compared to other states, Maine has a high percentage of physicians who are trained in palliative care.
On the downside, the rate of hospice use in Maine is very low, and most hospitals do not have hospice or palliative care programs. A majority of the state’s deaths do not occur at home, and nursing homes in the state do only an average job of managing the pain of residents. These and other findings indicate that the state needs to do more to prepare for the needs of the frail elderly and dying.
Key findings on the status of end-of-life care in Maine include:
• State advance directive policies — Maine’s advance directive policies earned an A grade because they support good advance care planning in the form of living wills and medical powers of attorney, designating a health care decision-maker should the patient become unable to communicate.
• Palliative care-certified physicians and nurses — The state received an A grade for the percentage of physicians trained in palliative care, and a grade of B for the percentage of nurses trained in the same field. This suggests that the state’s health care work force is doing a good job in preparing for current and future needs of the frail elderly and dying.
• Hospital end-of-life care services — Hospitals in Maine offer low levels of hospice and palliative care services. The state earned the lowest possible grade — an E — for the small percentage of hospitals (18%) reporting hospice programs and the low percentage of hospitals (15%) reporting palliative care programs. Such programs are considered the "gold standard" of end-of-life care. Maine earned an average C grade for the 45% of hospitals reporting pain management programs.
• Hospice use — Hospice care is not widely used in Maine. The state earned an E grade on this measure because only 9% of people over age 65 who died in the state used hospice in the last year of life. Moreover, the median length of stay in hospice care in the state was 27 days, which is less than the 60 days considered necessary for the maximum benefit from the program.
• State pain policies — Maine’s policies regarding pain management earned a B grade from Last Acts, because they allow physicians to treat pain at the end of life without undue scrutiny.
• Care in intensive care units at the end of life — Maine received a B grade from the Last Acts report for the relatively small percentage of elderly residents (7%) who spent a week or more in intensive care units during the last six months of life. This suggests that health care providers in the state do not provide overly aggressive care that does not take the patient’s treatment wishes into consideration.
• Location of death — A majority of Maine residents do not die at home, earning the state a D grade in this category.
Even states that ranked high in hospice use earned low grades overall on a national report card prepared by the Last Acts organization in Washington, DC.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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