Best and Worst States Providing Access to Palliative Care

2019 State-by-State Report Card shows rapid growth, but gaps in care remain for people living with a serious illness.

America’s Care of Serious Illness: 2019 State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals, released September 26, 2019 on Capitol Hill, demonstrates that access to palliative care continues to depend more upon accidents of geography than it does upon the needs of patients living with a serious illness and their families. This affects the 12 million adults and 400,000 children living with a serious illness, such as cancer, heart disease, kidney disease, or dementia.

According to the new report conducted by the Center to Advance Palliative Care (CAPC) and National Palliative Care Research Center (NPCRC), the U.S. shows continued 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. This is up from 67 percent in 2015, 53 percent in 2008, and 7 percent in 2001. These hospitals currently serve 87 percent of all hospitalized patients in the U.S. Yet, the overall 2019 grade for the United States is a B, unchanged from 2015 despite the continued growth of palliative care.

“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. “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.”

Key findings from the report include:

  • Three quarters of states now have a grade of A or B. 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.
  • 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.
  • Large nonprofit hospitals in urban centers remain the institutions 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.
  • 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.

Sean Morrison, MD, director of the NPCRC added, “High quality palliative care has been shown to improve patient and family quality of life, improve patients’ and families’ health care experiences, and in certain diseases, prolong life. Palliative care has also been shown to improve hospital efficiency and reduce unnecessary spending.”

Palliative care (pronounced pal-lee-uh-tiv) is specialized medical care for people living with a serious illness. This type of care 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 of doctors, nurses, and other specialists, palliative care teams work together with a patient’s other doctors to provide an extra layer of support. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It 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.

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.

About the Center to Advance Palliative Care
The Center to Advance Palliative Care (CAPC) is a national organization dedicated to increasing the availability of quality health care for people living with a serious illness. As the nation’s leading resource in its field, CAPC provides health care professionals and organizations with the training, tools, and technical assistance necessary to effectively meet this need. CAPC is part of the Icahn School of Medicine at Mount Sinai in New York City.,

About The National Palliative Care Research Center
The National Palliative Care Research Center (NPCRC) is dedicated to advancing palliative care research capacity in the United States. It works to rapidly translate important research findings into clinical practice in order to improve the care received by patients living with serious illness and their families. Led by R. Sean Morrison, MD, NPCRC is part of the Icahn School of Medicine at Mount Sinai, in New York City.

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