Report Card: Best and Worst States Providing Access to Palliative Care

A national study released last month on Capitol Hill, demonstrates that access to palliative care continues to depend more upon where a person resident rather than it does upon the needs of patients living with a serious illness and their families. This impacts 12 million adults and 400,000 children living with a serious illness, such as cancer, heart disease, kidney disease, or dementia.

Palliative care (pronounced pal-lee-uh-tiv) is specialized health care for people living with a serious illness. It is focused on providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.

Provided by a specially-trained team, palliative care works together with a patient’s other doctors to provide an extra layer of support. Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided along with curative and other life-prolonging treatments such as chemotherapy.

Photo Credit: Centers to Advance Palliative Care

According to the report, America’s Care of Serious Illness: 2019 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospital, released on September 26, 2019, by the Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC), the U.S. continues to show growth in the overall number of hospital palliative care teams: 72 percent of U.S. hospitals with fifty or more beds report a palliative care team today. This is up from 67 percent in 2015, 53 percent in 2008, and 7 percent in 2001.

The researchers noted that these hospitals currently serve 87 percent of all hospitalized patients in the U.S.

“As is true for many aspects of health care, geography is destiny. Where you live determines your access to the best quality of life and highest quality of care during a serious illness,” said Diane E. Meier, MD, director of the Center to Advance Palliative Care and co-author of the study, in a statement detailing the report’s findings. “The aging of the baby boomer generation is contributing to a growing population of patients in need who live for years with serious and chronic illness. The need to improve the quality of their health care is therefore urgent,” she says.

Growth, But Gaps in Care Remain

The 44 page report’s findings note that three quarters of states now have a grade of A or B (New York gets an A). The number of states with A grades (defined as more than 80 percent of the state’s hospitals reporting a palliative care team) increased to 21, up from 17 in 2015, and 3 in 2008.

The researchers found that four states (Delaware, New Hampshire, Rhode Island, and Vermont) show palliative care teams in all of their hospitals with fifty or more beds.  Four additional states (Connecticut, the Dakotas, and Utah) and the District of Columbia are one hospital shy of 100 percent penetration.

Mississippi, Alabama, Oklahoma, New Mexico, and Wyoming were the lowest-performing states, with fewer than 40 percent of hospitals reporting palliative care teams, say the researchers.

As to ownership type, large nonprofit hospitals in urban centers remain the most likely to provide access to a palliative care team. For-profit hospitals of any size are less likely to provide palliative care than nonprofit hospitals.

The researchers say that access to palliative care for people living in rural America remains limited. Ninety percent of hospitals with palliative care are in urban areas. Only 17 percent of rural hospitals with fifty or more beds report palliative care programs, they note.

Palliative Care’s Impact on Hospitals

“High quality palliative care has been shown to improve patient and family quality of life, improve patients’ and families’ healthcare experiences, and in certain diseases, prolong life. Palliative care has been shown to improve hospital efficiency and reduce unnecessary spending,” said R. Sean Morrison, MD, director of the National Palliative Care Research Center and coauthor of the study.

According to the report, federal and state policymakers could change the equation by focusing on key areas including: workforce, research, improving clinical skills, public awareness, and payment models linked to quality measures. Several states are already developing new initiatives and passing supportive legislation.

To see the details of this report, go to https://reportcard.capc.org/wp-content/uploads/2019/09/CAPC_ReportCard19-Digital_9_19.pdf.