Conference explores dying in prison

The first national conference on death and dying in prisons and jails was sponsored by New York City-based Project on Death in America (PDIA) and the Center on Crime, Communities & Culture (CCCC), was held Nov. 16 and 17 in New York. Keynote speaker for the conference, "Caring for Prisoners, Families and Caregivers," was Sister Helen Prejean, CSJ., author of the book Dead Man Walking, which was later made into a motion picture.

According to conference organizers, the field of dying inmates is largely unstudied despite the growing number of inmates dying in U.S. prisons and jails, and higher rates of suicide and AIDS. Resources to care for dying inmates, and bereavement support for their grieving survivors, including fellow inmates, are negligible at best.

However, a few innovative hospice programs and other supportive services were created in some institutions while community hospices have attempted to spur such development in others.

Earlier this year, a prison hospice opened at the Louisiana State Penitentiary at Angola, the largest prison in the United States. The Angola prison and hospice program are featured in a new documentary film called The Farm, which was shown and discussed at the conference, and in an article in the September 1998 PDIA Newsletter.

Tough sentencing laws

Louisiana has some of the toughest sentencing laws in the country, the article states. "The courts hand out a disproportionate number of life sentences; the parole board rejects all but a few requests. As a result, an estimated 85% of Angola’s 5,200 inmates will grow old and die there."

PDIA associate director Mary Callaway toured the prison last spring and said she was amazed to see elderly wheelchair-bound inmates among the prison population. "One of the five compounds or camps at Angola is just for the elderly population — the geriatric camp," she told the newsletter.

Objectives for the New York conference explored both the needs of inmates facing death and their caregivers; understanding how to advocate for, provide, and administer such care; and developing recommendations for policy change. Other sessions addressed epidemiology, legal issues, and how to deliver palliative care at the end of life.

For more information, visit PDIA’s Web Site: or the CCCC web site: Information is also available through Bill Gibbs of Imedex, the conference secretariat, at (770) 751-7332. Another important resource, the National Prison Hospice Association, can be reached at P.O. Box 3769, Boulder, CO 80306-0941. Telephone: (303) 666-9638. Fax: (303) 665-9437. E-mail:

Hospital bed rate decides where people die

By far, the number of hospital beds in a community is the strongest determinant in whether a terminally ill patient dies in the hospital or at home, according to a new study published in the October issue of the Journal of the American Geriatrics Society. Analysis of the wide geographic disparities in end-of-life care, based on data from SUPPORT (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treat-ments), a multisite study funded by the Robert Wood Johnson Foundation of Princeton, NJ, and the Dartmouth Atlas of Health Care, produced at the Dartmouth Medical School in Hanover, NH, challenges current assumptions about the choices patients might make if they were armed with better information.

The study indicates that unless local health care resources and practice styles are adjusted to meet the needs of dying patients, their wishes likely will not prevail. Over 80% of SUPPORT patients said they would prefer to die at home, but 55% of them died in a hospital. Nationally, 39% of all deaths in 1992 and 1993 were in a hospital; but this rate varied from 22% in Portland, OR, and Ogden, UT, to 54% in Newark, NJ. Medicare data suggest that a decrease of just one hospital bed per thousand population decreases the in-hospital death rate by 3.8%, while increased spending on hospice also corresponds with a lower rate of in-hospital deaths.

Hospice nurses move on multiple fronts

The Hospice and Palliative Nurses Association (HPNA), of Pittsburgh is moving forward on a number of fronts to advance the discipline’s standing. These activities include combining with other national hospice nurses associations, creating a foundation to promote education and research, and launching a peer-reviewed journal called the Journal of Hospice and Palliative Nursing, whose premiere issue will be released at the next HPNA annual conference, Feb. 10-13, 1999, in Clearwater, FL.

The Academy of Hospice Nurses (AHN), a smaller group allied with the American Academy of Hospice and Palliative Medicine (AAHPM) of Reston, VA, voted this summer to dissolve its organization and combine membership with HPNA. Of its 162 members, 43 already belonged to HPNA, and the rest joined HPNA’s total membership of over 3,000 nurses, effective Aug. 15.

"We’re excited about this merger," says Marty Ayers, HPNA’s executive director. "It makes a stronger organization for hospice nurses, with no splinter groups out there," not that AHN was pursuing a conflicting agenda, Ayers says. Another immediate result has been an increase in contact between the nurses group and AAHPM.

Meanwhile, HPNA’s affiliated National Board for Certification of Hospice Nurses (NBCHN) completed a national role delineation study of the critical professional tasks performed by hospice and palliative care nurses. Based on the results of that study, NBCHN is changing its name to the National Board for Certification of Hospice and Palliative Nurses, and revising the professional credentialing it offers to incorporate both hospice and palliative care nursing. New certification examinations beginning next March will award the designation CHPN (certified hospice and palliative nurse). In other changes, certification will no longer require a BSN degree or two years of full-time professional experience. For information on the certification program, contact NBCHPN at 211 N. Whitfield St., Pittsburgh, PA 15206, (412) 361-2470.

Congress boosts needlestick prevention

Another overlooked provision of this year’s omnibus spending bill is a provision calling for the dramatic reduction in accidental needlestick injuries to health care workers. (See Hospice Management Advisor, June 1998, pp. 75-77.) An amendment sponsored by Sen. Barbara Boxer (D-CA) urges federal worker safety agencies to require the use of safer needles in health facilities, as well as a more accurate reporting of accidents.

Although nothing in the law is mandatory, the Occupational Health and Safety Administration (OSHA) in Washington, DC, endorsed Boxer’s needle safety amendment.