MISSOULA – Life’s End Institute: Missoula Demonstration Project applauded a first-ever, nationwide, state-by-state ‘report card’ on end-of-life care released earlier today during a national news conference, even though Montana’s grades were mixed. The report, “Means to a Better End: A Report on Dying in America Today,” paints a statistical portrait of the availability and use of good end-of-life care in Montana and throughout the United States. The report is sponsored by Last Acts, a national campaign dedicated to improving care and caring near the end of life.

“For the first time, we have evidence-based indices on which to base our votes and our healthcare choices,” said Ira Byock, M.D., co-founder and principal investigator of Life’s End Institute: Missoula Demonstration Project. “‘The Means to a Better End’ report announces a new era of citizen and consumer action to improve how we die.”

The report suggests that most Americans will receive, at best, only mediocre treatment at the end of their lives. Montanans, as a rule, can expect no better. Montana received mixed grades across the eight indices: state advance directive policies, location of death, use of hospice, end-of-life services in hospitals, pain among nursing home residents, state pain policies, length of time spent in the intensive care unit at or near the end of life, and number of palliative care-certified physicians and nurses. In the latter two categories, Montana received a “B” and an “A” respectively. In the rest of the categories, Montana received “C’s” and “D’s.”

“Life’s End Institute applauds Last Acts for this ground-breaking and much needed study,” said Lilly Tuholske, acting director of Life’s End Institute: Missoula Demonstration Project. “Although it paints a pretty dismal picture of end-of-life care in America today, we know that here in Missoula, Montana, we have worked successfully to improve the quality of life’s end for dying people and their families. We have accomplished this by identifying gaps between what people want at the end of life and what they actually receive.”

Since 1996, Life’s End Institute has studied Missoula County’s values, expectations and fears in regard to dying, death, caregiving and bereavement. Those studies have fostered many successful projects, including the Choices Bank, a secure online repository for advance directives for healthcare, Caring Circles, a program that encourages support networks for family caregivers, and the development of widely distributed pain scales. Use of the pain scales contributed to commendations for both local hospitals from the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Tuholske stressed that while Montana actually had the highest percentage of physicians and nurses trained in palliative care (0.97%), no state had more than one percent of their physicians trained in this crucial type of end-of-life care. Montana only had eight trained palliative care physicians. Palliative care controls pain and symptoms while providing emotional and spiritual support to the patient and family, respecting their cultural traditions.

A public opinion poll accompanying the report reveals that Americans’ perceptions of end-of-life care range from fair to bad. Six in ten people give the current system a rating of only fair or lower. Almost half of those surveyed felt that the current healthcare system could not assure that a patient’s dying wishes would be followed. Tuholske acknowledges that there is a lot of work to do, but offers hope for Montanans.

“Montanans do have options at the end of their lives,” said Tuholske. “By using available resources such as the Choices Bank, or becoming involved with Caring Circles, we can have a voice in our life closures and experience safe, comfortable dying. Our families can be supported in their caregiving. And healthy grieving can become a part of fuller living among us all.”

See related media stories.
See the full report and related materials.
See the Montana results.

To view