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State's end-of-life care rates high, not ideal.

Byline: TIM CHRISTIE The Register-Guard

America does a mediocre job of caring for the terminally sick and dying, although Oregon caregivers do better than their counterparts in nearly every other state, a national report concluded Monday.

Most Americans would prefer to die at home, free of pain and surrounded by loved ones. Instead, too many are dying alone, in nursing homes, in pain and attached to machines they may not want, says the report from Last Acts, a national organization that works on end-of-life issues.

"Dying patients and their families today suffer more than they should," said Judith Peres, deputy director of Last Acts and leader of the report's research team. "We still have a long way to go to improve health care and policy for this segment of the American population."

Last Acts is a coalition of more than 1,000 groups, including the American Medical Association, the American Nurses Association, the American Hospital Association and AARP. Its report looked at the availability, quality and use of key services, such as hospice, palliative care, advance directives and pain management. The Robert Wood Johnson Foundation paid for the study, titled "Means to a Better End: A Report on Dying in America Today."

Graded in eight areas, Oregon ranked second in the nation, but it didn't exactly pass with flying colors: Its report card amounted to a C average. Only New Hampshire ranked higher, and then only marginally. Most states earned C's, D's and F's on most of the criteria.

"It does indicate there's a long way to go, not just here but nationally, in changing how we all deal with end-of-life care," said Mark Newson, a registered nurse and patient care manager for Hospice of Sacred Heart in Eugene.

The report found more terminally ill Americans are turning to hospice care - 700,000 in 2000 compared to 1,000 in 1975, when hospice care began - but spending fewer days in such care before death.

Fewer than one-third of Oregonians older than 65 who died in Oregon used hospice care in the last year of their lives, resulting in a C grade. The average length of hospice care was 24 days, netting a D grade. The report cites studies suggesting patients must participate for at least 60 days to get the maximum benefit of hospice care.

In other grades for Oregon:

The state received its lowest marks for the use of hospice and palliative care at hospitals. Only 39 percent of state hospitals offer hospice programs, a C, and still fewer, 20 percent, provide palliative care programs, a failing grade.

The state earned its highest grade, an A, for limiting the time patients spend in an intensive care unit at the end of life. Only three percent of state residents spent a week or more in an ICU in the last six months of life. This suggests health care providers are taking patients' treatment wishes into consideration and not prolonging discomfort, the report said.

The state earned a B for its advance directive policies. State laws support good advance-care planning in the form of living wills and medical powers of attorney. These documents, explaining how much life-sustaining treatment a patient wants, are considered critical to end-of-life care.

The state also got a B for the number of registered nurses trained to provide palliative care, though it got only a C for training physicians to provide palliative care.

Only about 35 percent of Oregonians die at home, earning the state a C grade. That's better than the national average of 25 percent. About 70 percent of Americans say they want to die at home.

Nearly 40 percent of nursing home residents report being in persistent pain, earning the state a C.

The Last Acts report recommends that Medicare be reformed to meet the needs of seriously ill and dying people. It calls on state legislatures to change rules that discourage doctors from prescribing adequate pain medication. Health care professionals should get more training in palliative care, and family members need to learn more about these issues before placing a loved one in a nursing home, the report says.

Palliative care - often contrasted with curative care and confused with hospice care - means caring for the whole person, "body, mind, spirit, heart and soul," the report says. "It looks at dying as something natural and personal."

Locally, both Sacred Heart Medical Center and McKenzie-Willamette Hospital have hospice programs, and Sacred Heart has had a palliative care program for about two years, Newson said.

Palliative care should begin earlier in the disease process, Newson said. Doctors can treat a patient's illness, but the patient still needs a broad spectrum of support, including counseling and spiritual care, he said.

`These (programs) are for people who are just not ready to say, `Let's stop these treatments and let nature run its course,' ' he said.

While Oregon ranked high for its advance directive policies, "we still have a long way to go," Newson said. Americans live in a "death-denying culture," he said, and patients and family members are afraid if they start talking about end-of-life issues it will somehow hasten death.

"It is one of the toughest conversations to have," he said.

Some physicians are unwilling to have such conversations with patients, and some families and patients don't want to hear it, he said. At the same time, advancing medical technologies enable physicians to extend a person's life considerably.

Newson said he's hopeful the report will get people thinking and talking about the end of life. The point, he said, is not to dwell on the morbid but to deal with death "as part of the natural life cycle and do advance planning and not be afraid to have these conversations."

The Associated Press contributed to this report.


Last Acts, a national organization, has released a report ranking each state and the District of Columbia on the quality of end-of-life care.

Top 5: 1. New Hampshire; 2. Oregon; 3. Maine; 4. New Mexico; 5. Arizona

Bottom 5: 47. South Dakota; 48. Tennessee; 49. Idaho; 50. South Carolina; 51. Alaska

Our neighbors: 8. Washington; 12. Montana; 22. California; 49. Idaho

For more information: Go to the Last Acts Web site at, or to read the full report, go to the Robert Wood Johnson Foundation Web site,

- Last Acts
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Title Annotation:Dying: Oregon ranks 2nd in the nation, but gets a C on an organization's report card.; Health
Publication:The Register-Guard (Eugene, OR)
Geographic Code:1U9OR
Date:Nov 19, 2002
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