End-of-Life Care Gains Attention in States

By early 1998, at least 20 states had commissions or task forces to examine end-of-life care. Bills being considered during 1999 legislative sessions echo many of the same trends as the task forces: increasing access to better pain control and comfort care for terminal patients, especially through Medicare and private insurance, and improving the use of advance statements by patients about their preferences for end-of-life-care.

Twenty states are considering bills to improve end of life care in this year’s session. These bills are increasingly in the spotlight because of public debates about physician-assisted suicide and dissatisfaction with current options for end-of-life health care.

The goal of end-of-life care is to keep patients comfortable and, whenever possible, provide that care in a setting the patient chooses. Options for state legislators to improve end-of-life-care include the following:

• Expanding the Medicare definition of "terminally ill" to ensure Medicare recipients are eligible for hospice care beyond the current mandated criteria of a six-month survival prognosis. Not all terminal diseases have the same prognosis; a patient diagnosed with a progressive illness such as Alzheimer’s may have a five-year life expectancy while a cancer patient may have only a six-month life expectancy.
• Shifting the emphasis for Medicare and private insurers toward reimbursing pain control and comfort care services in the home—including hospice care—rather than aggressive, curative care in the hospital. In polls, most people say they want to die at home. End-of-life care that provides pain control and comfort care helps patients die comfortably in a home or other residential setting.
• Encouraging state insurance commissioners to explore private insurance coverage of chronic pain and palliative care.
• Holding licensed facilities accountable for good outcomes in end-of-life-care.
• Adding end-of-life-care training components to the education of doctors, nurses and social workers. Such requirements may be linked to the receipt of Medicare funds or state funds.
• Ensuring that the public is educated about end-of-life-care. States could produce and distribute a brochure that explains hospice and home health end-of-life care.

To order State Initiatives in End of Life Care: Policy Guide for State Legislators, call the Center to Improve Care of the Dying (202/467-2222) or the National Conference of State Legislatures (202/624-5400). For more information about hospice care, call the Hospice Foundation of America (202/638-5419).