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Oregonians prefer to die at home With access to hospice, trend holds true here By SUSAN JAY Terminally ill Oregonians are more likely to die where they want to than residents of any other state. Most Americans prefer to die at home or in a home-like setting instead of in a hospital, and Oregon researchers say that's what's happening here. In Oregon, 31 percent of all deaths in 1996 occurred in a hospital. That was the lowest percentage in the country. Nationally, the rate in 1995 was 56 percent. That number did not change significantly the next year, researchers said. Of the 69 percent of all Oregon deaths occurring outside a hospital in 1996, 31 percent occurring at home, 31 percent in nursing homes and 7 percent in other locations. "We are seeing a majority of people who actually made a well-thought-out plan for their terminal illness. We are doing more advance planning in Oregon and it matters," said Susan Tolle, lead author of a research project by the Center of Ethics at Oregon Health Sciences University, published Monday in the Annals of Internal Medicine. The study concluded that the state has such a low rate of in-hospital deaths for three reasons: First, Oregon families lead the country in advance planning for end-of-life care. Second, the state has a unique doctor-signed form that helps ensure that the wishes of the dying are followed. Finally, Oregon has more nursing and foster care homes and hospice services than other states. "I think it's great," Medford physician Pat Gillette said of the findings, "because people would prefer to die at home." He specializes in geriatric care and is medical director for the Rogue Valley Manor and Medford Rehabilitation. Gillette is a strong believer in advance planning. "It's hard to resolve the issues of death and dying when someone is at the door (in a crisis situation). It's a lot easier to talk about before something happens." More Oregonians seem to be doing just that. OHSU researchers conducted two studies to explain the growing numbers of Oregonians dying outside the hospital. In a 14-month study, following 475 families who had a loved one die between 1996 and 1997, OHSU researchers found that: 67 percent had written advance directives spelling out what they wanted concerning life-sustaining treatment. 79 percent of the families decided never to start life-sustaining treatment, and 21 percent decided to withdraw life support. 93 percent of the families believed they knew what their loved ones wanted. Only 6 percent of the patients died in a nursing home after being transferred from a hospital at the initiation of a health care provider. As the latter figure and others show, discharging dying patients to a nursing home close to the time of death was not the primary factor in the high number of outside-hospital deaths, Tolle said. "In Oregon, decisions not to admit occur more frequently than decisions to discharge patients who are near death," she wrote. In another study, OHSU researchers evaluated the effectiveness of the Physicians Orders for Life Sustaining Treatment or POLST form. It's a bright pink form signed by the patient's doctor that can limit life-sustaining treatment, including cardiopulmonary resuscitation, in case of unconsciousness or a medical crisis. The form accompanies the dying patient in the ambulance, from home to nursing home and hospital. The researchers followed a statewide sample of 316 Oregon nursing home residents. All of them had a do-not-resuscitate order and 180 had the POLST forms with specific orders to transfer them to a hospital only if comfort measures failed. Of the 91 patients who died, 86, or 94 percent, died in the nursing home. This result "suggests" that deaths in nursing homes "are associated with advance planning and requests not to be transferred to the hospital unless comfort measures fail," the research article said. Tolle said one reason Oregonians know about advance planning and end-of-life care is because of the lengthy debate over physician-assisted suicide, which voters legalized in 1994 and refused to repeal in 1997. Other factors include Oregon's extensive network of services for the dying, including hospice, nursing homes and foster care, not always available in other states. Mail Tribune Copyright � The Mail Tribune 1999, Medford, Oregon USA