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SUMMARY
FOR POLICY MAKERS
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“The
under-treatment of pain is a well-documented public health
crisis in this country”
Senator
Ron Wyden
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Oregon
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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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