March 01, 2003

Georgia receives end-of-life care report card

November 18 the Last Acts organization, a national coalition dedicated to improve end of life care, released the report "Means to a Better End: A Report on Dying in America Today". The report is based on indicators chosen by a national panel of experts; indicators included:

  • advance care planning,
  • the site of where deaths occur,
  • utilization of hospice care,
  • time spent in intensive care,
  • pain management, and
  • physician and nurse training.

Each state was rated according to these indicators.

How did the state of Georgia fare? Not very well. The highest grade that Georgia received was a “B” (on a scale of A through E, with A being strongest) in one area: the degree to which state law supports patients in advance care planning, planning for the kind of medical care individuals prefer when they are no longer to speak for themselves.

  • There are opportunities for improvement in many areas: State and national research indicates that people’s images of a good death typically include dying at home. Only 19.3% of Georgians died at home (1997 figures). 63.7% die in hospitals and 17% die in nursing homes.

  • Utilization of hospice care could be improved. Only 24.2% of Georgians over the age of 65 used hospice in the last year of life, and the average length of hospice stay was 25.4 days. Hospice’s philosophy of comprehensive care of the patient and family could be of greater benefit if introduced much earlier in the patient’s course of illness.

  • Many Americans report a fear of living their final days in intensive care, hooked up to machines and surrounded by strangers. 32.7% of Georgians over age 65 had a stay in intensive care units during the last six months of life. 12% spent a week or more in intensive care units during this time.

  • Georgia’s state policy on pain management was rated as including significant barriers to good pain management. Georgia was seen as lacking a comprehensive pain management policy, and that existing regulations did not explicitly address the needs of terminally ill patients. State guidelines on the use of controlled substances were determined to include provisions that discouraged the prescribing of pain medications. Guidelines also lacked language that would reassure physicians on their ability to prescribe opioids for pain management or that expressed concern about the undertreatment of pain.

  • All 50 states were challenged to encourage a greater percentage of health care professionals to acquire certification in palliative care. At present no state had more than 1% of physicians or nurses certified in palliative care.

The overall report indicates significant shortfalls across the US, but acknowledges coalition efforts in many states that are actively working on improvements in many components. The Georgia Collaborative is one of those efforts.


[ Posted by Kathy Kinlaw at March 1, 2003 01:22 PM | More HCECG articles ]

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