End-of-life care in isles
receives mixed marks

A report says the state fares better than
others but still could improve

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By Jaymes Song
Associated Press

Many people retire in Hawaii to spend their final years in warm weather surrounded by beautiful beaches.

But a new report says it may not be the best place to die.

When it comes to caring for those in the final stages of life, Hawaii gets a mixed review, according to a "report card" released today on the state's end-of-life care.

Only 23 percent of people in the state die at home, although most Americans say that's the way they want to go, the report said.

The report by Washington, D.C.-based Last Acts, a national coalition to improve end-of-life care, states that terminally ill and dying Hawaii residents are well served in some aspects but poorly served in others.

Hawaii received two As, a B, three Cs, three Ds and three Es in the "Means to a Better End: A Report on Dying in America Today." The report did not give states overall grades or make any comparisons among the states.

Hawaii apparently fared better than most states however, since very few received any top grades, the report said.

The report said about a third of nursing home patients in Hawaii suffer persistent pain, although that was good enough for a B grade and a declaration that nursing homes in the state generally do a good job of managing pain.

"While we feel there're tons of ways that we can improve what's going on here, if you just knew where we were 3 1/2 years ago," said Marilyn Seely, director of the state Executive Office on Aging. "There was very little attention being paid to people at the end of their lives."

A grant by the Robert Wood Johnson Foundation in 1999 has made major end-of-life care improvements statewide, including helping to create a public-private partnership called Kokua Mau, which means continuous care in Hawaiian, state officials said.

Hawaii fared best in caring for dying patients in the Intensive Care Unit of hospitals and in supporting living wills and medical powers of attorney for dying patients.

Hawaii has a "relatively low percentage of elderly residents who spend a week or more in ICU in the last six months of life, which suggests that physicians are taking patients' treatment wishes into consideration," the report said.

"On the downside, most hospitals in Hawaii do not have hospice or palliative care programs," the study said.

Hawaii also received failing grade in state policies on pain management.

The study says its grades are based on data sometime no earlier than 1997.

"A good deal of our work has been done in the last three to four years, so I think if they were to gather the facts now we would see a very different report card," Seely said. "We probably won't all be A's, but I don't think we would have these two Es."

Among the more recent improvements are new legislation, as well as nursing school students, hospitals and nursing home staff receiving end-of-life training.

Jeannette Koijane, program director at the state Executive Office on Aging, said talking about a person's wants in their final stages of life is still a "taboo" subject for many people.

"So what we've been trying to do is bring up the subject long before," she said. "People need a chance to plan, think about it, talk it over with their families and document their wishes."

Hawaii also received a "D" grade in the "location of death" category, saying the majority of residents do not die at home, although most Americans prefer to be at home with their loved ones.

Seely said a lot of people in Hawaii are sent from their homes or nursing homes to die in hospitals.

"If they're at home, people panic and haven't perhaps had the help of folks like hospice that would guide them, tell them what to expect and offer them support," she said.

There are also cultural considerations. Some cultures would like to avoid a family member passing away at home because they believe there's a spiritual presence that they would like to avoid, Seely said.