The report, Means to a Better End: A Report on Dying in America Today, evaluates states on the following categories: state policies regarding living wills and medical power of attorney documents, proportion of deaths occurring at home, hospice use, hospital end-of-life care services, care in Intensive Care Units at the end of life, pain among nursing home residents, and state pain-control policies. Most states earned grades of C or below in the majority of the categories.
Overall, assessing states based on these criteria paints a picture of how well they provide palliative care near the end of life. Palliative care, as described by Last Acts, “works aggressively to relieve pain and other physical symptoms; it also offers emotional and spiritual support to the patient and family, while respecting their culture and traditions.”
Last Acts found that in most states “too few patients are accessing hospice and palliative care services, there are too few professionals trained in pain management and palliative care, and there are too many patients dying in hospitals and nursing homes — in pain — rather than at home with their families.”
“Dying patients and their families today suffer more than they should,” Judith R. Peres, deputy director of Last Acts and the leader of the report’s research team, said. “We still have a long way to go to improve health care and policy for this segment of the American population.”
Last Acts also released a national survey on Monday showing that a significant number of Americans, including those who have recently lost a loved one, are dissatisfied with the way the country’s health care system provides care to the dying. Out of those who recently lost someone close to them, 59 percent rate the American health care system’s care for the dying as being fair or poor. Those surveyed complained the most about the cost of end-of-life care: 49 percent of those who had lost someone rated the system as poor for its ability to insure that “families’ savings are not wiped out by end-of-life care.”
This study was launched on the heels of a report published in the Journal of the American Medical Association documenting the high costs of end-of-life care, the unnecessary pain and isolation dying patients experienced, and their experiences with doctors who did not understand their wishes. An Institute of Medicine report published in 1997 echoed those findings and underscored that “people have come to both fear a technologically over-treated and protracted death and dread the prospect of abandonment and untreated physical and emotional stress.”