End-of-life care receives failing grades

Some states are better than others, but a report by Last Acts finds that each state needs to make improvements in palliative care.

By Andis Robeznieks, AMNews staff. Dec. 9, 2002.

"Mediocre" is the word often used by advocates of seriously ill and dying patients to describe the care these patients receive in this country. Now there's a report that backs up that word choice.

Last Acts, a coalition of groups working to improve end-of-life care, recently released "Means to a Better End: A Report on Dying in America Today," a report that grades each state in several categories, including: advance-directive policies, location of death, rate of hospice use, hospital palliative care services, pain policies and the number of physicians certified in palliative care.

"Surprisingly, there is no state that did well across the board on all issues," said Judith Peres, a clinical social worker and Washington, D.C.-based Medicare policy analyst with Last Acts. "Across the board, the delivery of end-of-life care is mediocre."

Brad McKinney, project director for the Michigan Hospice & Palliative Care Organization, Lansing, Mich., disagreed with Peres's assessment on the quality of care being offered but agreed with her statement on its delivery.

"I think there is quality care being offered in every county throughout the state," McKinney said. "It's not the care that's mediocre. It's the utilization and access that's poor to mediocre at best.

"We just aren't getting the services to people early enough and widespread enough," he said.

Despite disagreeing with some aspects of the report, McKinney said he hoped that the media coverage it generated would encourage families to discuss end-of-life care. [...]

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