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Facts On Dying:
Policy relevant data on care at the end of life
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The under-treatment of pain is a well-documented public health crisis in this country”

Senator Ron Wyden
- Oregon


Why Should Policy Makers Focus on Pain Management in Nursing Homes?

Increasing numbers of Americans are dying of progressive, chronic illnesses, and nursing homes have become our most common site of death.  Projections show that by the year 2020, the proportion of elderly Americans who will die in nursing homes will double to 40%. For example, in Rhode Island, in 1989, 19.5% of all non-traumatic deaths occurred in nursing homes, while in 1997 this number increased to 33.1%, almost a 55% increase within eight years. For on overview of how the site of death has changed between 1989 and 1997 in the United States of America, click here.

Now that nursing homes are becoming the prevalent site of death in the United States, an important research question is whether our nursing homes are providing quality end of life care. Our recent findings demonstrate woefully inadequate pain management and the urgent need for balance in our public policy, and improvement in treatment strategies.

The key finding is that 41.2% of persons in pain at the first assessment within 60 days of April 1, 1999 experienced either moderate daily pain or excruciating level of pain at a second assessment, 60-180 days later. While this rate varied, there are important opportunities to improve pain management in all states of the United States.

What are the Next Steps for Policy Makers?

First, pain should be a focus of federal and state inspection in nursing homes. The rate of persistent pain should be a quality indicator that is reported publicly.

Second, nursing homes should partner to improve the quality of pain management for its residents.

Third, consideration should be given to establishing and funding national centers of excellence to help nursing homes in their efforts to improve.

Fourth, nursing homes are now faced with staff shortages and high rates of turnover. Improving the quality of care will need to address this issue.

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