Hawai'i gets mixed reviews in report on end-of-life care

By Jaymes Song
Associated Press

HONOLULU — Many people retire in Hawai'i 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, Hawai'i 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 Hawai'i residents are well served in some aspects, but poorly served in others.

Hawai'i received two A's, a B, three C's, three D's and three E's in the "Means to a Better End: A Report on Dying in America Today." The report did not give states an overall grades or compare the states.

Hawai'i apparently fared better than most states however, since very few received top grades, the report said.

The report said about a third of nursing home patients in Hawai'i 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 are 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, state officials said.

Hawai'i fared best in caring for dying patients in the intensive care units of hospitals and in supporting living wills and medical powers of attorney for dying patients.

Hawai'i 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 Hawai'i do not have hospice or palliative care programs," the study said.

Hawai'i also received failing grades 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 E's."

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 what a person's wants in their final stages of life can still be a "taboo" subject.

"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."

Hawai'i also received a "D" grade in the "location of death" category, because 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 Hawai'i 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 the cultural considerations. Some cultures would like to avoid a relative dying at home because they believe there is a spirit that they would like to avoid, Seely said.