Reports on the States
State laws lag
|Given the relative speeds of
innovation in medicine and legislation, it should come as no surprise
that the legal climate and medical practice are inconsonant with the
There has been progress. When this page was first written only three states had adopted the POLST model document, Oregon, New York, and West Virginia. Now (2014) as shown above left in shades of pink, POLST has been endorsed by sixteen states and is in-process in all but eight of the rest.
The Robert Wood Johnson Foundation sponsored a program which, among much else, graded the US states on their treatment of end-of-life. Pennsylvania got a below average grade.
is about average, but with a D grade. I've compiled this table
their data. It color codes the grades from blue for A down to
for E. The PA grade is shown with this color coding, Then the
distribution of grades among the sates is shown, with the modal grade
highlit in the color coding. The last column compares the PA grade to
the modal grade. Here we find that PA has the modal grade
in 8 of the
12 categories. What I found striking was that in more than half of the
categories no state rated an
A grade. And in a third of categories, no state got a B.
Pennsylvania's Department of Aging commissioned a report on improving end-of-life experiences. The brief and full versions are cited at the right.
The summary states the task force's primary goals:
■ To create momentum for change in policy, systems, and grassroots community activity to reform and improve palliativeThey go on to say:
and end-of-life care;
■ To mobilize stakeholders in the public and private sectors for action by providing them with information and pathways toward
reform of palliative and end-of-life services and care;
■ To energize local citizen action groups throughout the state to organize and create change around palliative and end-of-life care.
In sharp contrast to 1900, when acute infections constituted the leading causes of death, today most people die from chronic progressive illnesses. The cumulative effects of these illnesses on individuals and their families present an increasingly urgent challenge for our health care delivery system ... . all require action by providers and policy makers to address issues associated with serious illness and the need for improved palliative and end-of-life care.Basically, people are staying alive to older ages and the health care system has not adapted. Pain is not managed well. Hospitals are used where less expensive alternatives would be more pleasant and more suitable. Laws inhibit adoption of new policies.
|In all, the task force produced 160 recommendations in these categories:|
- improved, more supportive policies
- greater awareness
- continuity across care settings
|Provision of Palliative Care|
|Palliative care is patient- and family-centered care
quality of life by anticipating, preventing, and treating suffering. ...
New national initiatives standardize the practices of palliative care: The National Consensus Project for Quality Palliative Care (NCP) and the National Quality Forum's (NQF) Framework and Preferred Practices for a Palliative and Hospice Care Quality Project.
- create a web-based statewide clearinghouse for palliative care
- for a medical license, require evidence of baseline education in palliative care
- increase funding for scholarships
- offer incentives for advanced training in palliative care
- adopt the Model Guidelines for the Use of Controlled Substances for the Treatment of Pain
- A single state agency should oversee compliance with the national standards
|Medicare currently spends 27% of its total dollars on
are in their last year of life. About 70% of people who die each
year are covered by Medicare, with about 13% also covered by
Medicaid. Coverage biased toward hospital stays, which are more expensive than appropriate alternatives.
- explore new models of care delivery through demonstration projects that focus on redistributing and realigning incentives to provide patient-centered care and quality of life rather than incentives for over-treatment and lengthening of life at all costs.
- reverse policies that restrict people on the Medicare hospice benefit from also receiving home-based services
- invest in palliative care programs and integrate them into routine care
|Populations with particular concerns include: older
adults, children, racial-ethnic minorities, people with disabilities,
rural populations, and prison populations.
- need appropriate safeguards for all
|Inadequate professional palliative and end-of-life
- educational reform is needed
|Raising Awareness in the Community|
|Need to improve the public's understanding of
palliative care and the end-of-life experience. Especially in regards to
- dying in the context of significant personal relationships
- support for the lay caregiving experience
- hospice and palliative care
- pain and symptom management
|Research, Measurement, and Data|
|- need improved systems for research, analysis, measurement, and tracking of efforts in palliative and end-of-life care|