End of Life Care Project Reports
End-of-Life Care in New Hampshire: A Report from Communities
This report shows that though end-of-life care in New
Hampshire has improved in the past four years, most people
who die in our state are still not experiencing optimal
end-of-life care. The release of this New Hampshire data
follows the release Tuesday of the first-ever state-by-state
analysis of end-of-life care which was based on data from
2000.
- View
the full report
- Read the press release from 11/20/02
Compassionate Care:
A Survey of End-of-Life Care and Faith Communities in New
Hampshire
The Foundation for Healthy Communities' N.H. Partnership for End-of-Life Care decided to explore issues related to how faith communities in New Hampshire are engaged in providing care and support to the terminally ill and their families. This decision was based on the recognition that spiritual care is an important component of quality end-of-life care and that faith communities or congregations are an important resource in offering spiritual care. The Compassionate Care Committee, with chaplains and clergy representation from the major Christian denominations and the Jewish faith, was organized to guide this study.
Click here to view survey and full report
Advance Directives in New Hampshire:
A Statutory Review & Survey of Current Issues
This report provides information on the Advance Directives (Living Will and Durable Power of Attorney for Healthcare) in order to improve their use in New Hampshire. The report identifies the problems with the current documents and examines areas for improvement, including references to similar documents in other states. Survey results from New Hampshire professionals who work with these documents are included. Mitch Simon, Professor of Law at the Franklin Pierce Law Center, is the principal author. This report is part of a much broader statewide effort to promote advance care planning -- the process of understanding, reflecting on, discussing and planning for a time when you are unable to make your own medical decisions. A revised advance directive guide is due in spring 2001.
View Advance Directives Report Online:
Table of Contents
Report
Appendix
Hospice Care and New Hampshire Medicaid Enrollees Report
This report was developed to assist health policy makers in understanding who might use hospice care or another end-of-life care benefit if Medicaid paid for it and how Medicaid enrollees are currently served. It includes an analysis of Medicaid claims data from the NH Department of Health and Human Services and information from New Hampshire hospice providers to provide a better understanding of resources used in end-of-life-care for Medicaid and low-income consumers. A policy objective of the NH Partnership for End-of-Life Care is to study of the potential for establishing a hospice benefit for Medicaid enrollees. New Hampshire is one of only six states that does not offer such a benefit. Access to comprehensive, high-quality end-of-life care for all regardless of income level is a priority of the Foundation for Healthy Communities.
To View or Download the report: Table of Contents and Report.
End-of-Life Care Planning in New Hampshire: A Statewide Survey
A recent survey of more than 1,000 NH adults by the NH Partnership for End-of-Life Care found that 42% have never had a conversation about plans for end-of-life care. More than half of the adults who participated in the survey have no advance directives, either the forms to designate someone as a Durable Power of Attorney for Health Care to make decisions if a person is unable or a Living Will.
On Tuesday, May 9, 2000, the Partnership held a press conference to release the results of their first-ever Statewide Survey on Concerns About End-of-Life Care. The report highlights who people are talking with about their end-of-life concerns and what their concerns are.
DEATH in NEW HAMPSHIRE: A Review of Medical Charts
This is the first statewide study on end-of-life care in the Granite State. Through the extraordinary volunteer efforts of the NH Partnership for End-of-Life Care, the study collected data on nearly 800 deaths in hospitals, nursing homes, home care and hospices during a 2-month period (October & November 1998). The report provides information on symptoms and treatments in the last 48 hours before death, directives, diagnoses, and other end-of-life care issues.
DEATH in NEW
HAMPSHIRE: A Review of Medical Charts
EXECUTIVE SUMMARY
Hospitals, nursing homes, home care agencies and hospice
programs in New Hampshire were invited to participate in a statewide,
voluntary, medical chart review project to document end-of-life care
issues. The information, based
on 786 adult deaths (age 18 years or older) in October and November 1998, was
compiled to provide baseline data on end-of-life care issues and assess
interest among health provider organizations in end-of-life care
concerns. Some key findings
include:
The average age of decedents in the study was 76 years.>For nursing home decedents, the average age was 84 years. More than half (55%) of the decedents in the study were female.
Forty-five percent of decedents in the study were married. Most nursing home decedents (62%) were widowed.
Lung cancer was the most frequently identified primary diagnosis representing 10% of decedents in the study. It was followed by congestive heart failure (7%), Alzheimers disease (2%) and strokes (2%).
While one third of cases in the study were known to be in hospice programs, 28% of those cases entered hospice care in the week before they died.The average length of stay among hospital decedents was 8 days and for nursing home decedents it was 712 days, almost 2 years.
Seventeen percent of the total number of decedents or 40% of the hospital cases were in a hospital intensive care unit (ICU) at the time of death or within that last 48 hours before death.
Pain/Discomfort was the problem or symptom assessed most often by all health providers in the last 48 hours before death (88%). This assessment of symptoms was followed in frequency by shortness of breath (75%), anxiety/confusion/agitation (74%), lack of appetite (60%), fever (58%) and difficulty swallowing (48%).
The familys emotional needs were noted in 74% of charts and 20% of the charts recorded a chaplaincy or spiritual care consult in the last 48 hours before death.Treatments provided in the last 48 hours before death: narcotics (75%), foley catheter (43%), IV fluids (42%), antibiotics (23%), intubation/ventilator (12%) and enteral tube (10%).
One half of the decedents had a living will and 57% had a durable power of attorney for health care (DPAHC). There were do not resuscitate (DNR) orders for 87% of all the deaths.
Only about a third of persons under age 55 years had a DPAHC or living will while nearly half of persons 55-84 years had these two directives.
Medicare was the primary insurance (64%), followed by Medicaid (12%), managed care (7%) and private commercial insurance (7%) for all organizations. Managed care was higher among home care/hospice cases (12%).
The chart audit identified variations among the individual organizations that submitted data.The findings are being used to inform health professionals and the public and initiate statewide efforts to improve the delivery of end-of-care in New Hampshire.
For more information about the New Hampshire Partnership
for End-of-Life Care,
contact Shawn LaFrance at slafrance@nhha.org.