Sunday, December 01, 2002
Copyright © Las Vegas Review-Journal

LETTER: Nevada moving in right direction when it comes to care for dying

To the editor:

The first ever state-by-state report card on the experience of dying in America -- released Nov. 18 -- is a reminder of why so many of us fear the end of life. Means to a Better End, written by the Last Acts national campaign of more than 1,000 consumer and professional organizations, demonstrates that far too many Americans die in pain, alone, having spent too much time receiving invasive (and expensive) life-prolonging care that cannot improve their conditions.

Too few doctors, nursing homes and hospitals have the training or programs to help people nearing the end of life die comfortably. Too few Americans are using hospice programs. And so, too few of us or our loved ones receive the emotional, spiritual or social support we need to do the necessary work of dying -- making peace with oneself and others and saying goodbye.

While aspects of care are better in some states than others, the report concludes that in Nevada, as elsewhere, care for the dying is no better than mediocre.

The encouraging news is that Nevada seems to be moving in the right direction on a few fronts -- Nevada's state regulations on pain medications (thanks to the Nevada State Medical Association and the Nevada Center for Ethics and Health Policy, along with others) and the number of residents over age 65 who used hospice care programs stand out. And this year, the Nevada Center for Ethics and Health Policy, through a grant from the Trust Fund for Public Health, developed the booklet, Caregiving in Nevada, featuring articles on health care ethics, pain management, bereavement support and caregiver burnout.

The booklet was distributed to 1,300 consumers, senior centers, health care facilities, nursing homes and several other groups with an interest in end-of-life care.

But on most other measures -- percentage of doctors and nurses with training in palliative care, numbers of nursing home residents reporting persistent pain, number of hospitals with hospice or palliative care programs and the quality of state advance directive laws -- we are lagging far behind.

We have much work to do to make dying a more humane, compassionate and pain-free experience. Creating consumer demand for quality services by making such data publicly available is an important first step. It is also time to start holding our public officials accountable for their role in improving the picture. The state's legislators, schools of medicine, nursing and social work, boards of medicine, pharmacy and nursing as well as state associations for hospitals, nursing homes and HMOs all must become actively involved and accountable for improving care of Nevada's residents who are in advanced illness nearing the end of life.

The Last Acts report card gives eight measures for quality end of life care. Nevada ranks quite poorly overall. There is such a thing as a good death, one with comfort and dignity. But we need the demand of Nevada's residents and action from local health care officials, spiritual leaders, and policymakers to improve our odds of having one in Nevada.

PAMELA M. DALINIS

LAS VEGAS

The writer, a registered nurse, is assistant director of the University of Nevada-Reno's Las Vegas/Southern Nevada office.