Access to palliative care across the U.S. varies widely. It often depends more upon accidents of geography, whether a hospital is for-profit or nonprofit, and hospital size than it does on the needs of patients living with a serious illness, and their families, according to a new state-by-state report card from the Center to Advance Palliative Care (CAPC).

The report concluded that while progress has been made in key areas, significant gaps in still remain. Growth continued in the overall number of hospital palliative care teams, with 72% of hospitals with 50+ beds reporting such a team. This is up from 67% in 2015 and 7% in 2001. These hospitals serve 87% of all hospitalized patients in the U.S. However, the overall national grade in 2019 is a B, unchanged from 2015, according to the report. One-third of the states received a grade of C or D.

This interactive map shows how each state rates.

Among the report’s key findings:

• Three quarters of states have a grade of A or B. The number of states with A grades (defined as more than 80% of the state’s hospitals reporting a palliative care team) increased to 21 from 17 in 2015 and 3 in 2008.
• Nonprofit hospitals are more likely than for-profit hospitals to provide palliative care.
• While 94% of hospitals with more than 300 beds have a palliative care team, one-third of U.S. hospitals with 50 or more beds report no palliative care services.
• Care varies widely by region. In the south-central U.S., no state gained an A or B grade and less than one-third of hospitals in Arkansas, Mississippi and Alabama reported a palliative care team. These south-central regions are most in need of improvement. In comparison, the northeast and mountain regions have almost universal access to hospital palliative care.
• Access to palliative care in rural areas remains limited. Ninety percent of hospitals with palliative care are in urban areas. Only 17% of rural hospitals with fifty or more beds report palliative care programs.

Palliative care focuses on providing relief from the symptoms and stress of living with serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is based on the needs of the patient, not on the patient’s prognosis. It is appropriate at any age and at any stage in a serious illness, according to CAPC.

According to the report, areas in need of change include:

• boosting the workforce pipeline;
• improving financing and financial incentives to ensure equitable and reliable access;
• improving accountability for access to high-quality care delivery;
• closing gaps in the evidence base to build the science guiding clinical practice;
• improving clinician training in communication;
• pain and symptom management, family assessment and support;
• increasing public knowledge about the benefits of palliative care.

CAPC points out the grades represented in the report card are based solely on the existence of palliative care teams in hospitals and did not examine timeliness, reach, or quality of hospital-based palliative care programs. It also does not take into account non-hospital palliative care services.

Data came from the American Hospital Association (AHA) Annual Survey Database for 2017 and were supplemented with data from 2016 for non-responders. Additional data on hospital palliative care programs were obtained from the National Palliative Care Registry and CAPC’s Mapping Community Palliative Care initiative. Analyses were limited to hospitals that either responded to the AHA Annual Survey or participated in the registry or mapping initiatives.

Journalists: What is your state doing to address these gaps? These additional tables and charts from the report can help inform your reporting on availability, access, and use of palliative care services.