Utah is 'best place' to die

Dr. Dick Wetzel is winding down, plagued by congestive heart failure, no longer able to walk, sometimes hallucinating, often weak. But he's doing it at home, with his wife, Betty, and their four dedicated children who have arranged their lives to travel from across the state and even the nation to take turns helping their folks.

Dying in your own bed is both a nightmare and a dream come true. And the fact that so many Utahns have a chance to die at home with help from family, friends and professional hospice care is one reason that Utah ranked No. 1 in Forbes magazine's list of best places to die.

The report says that geography may determine much about how we die, including whether people die in a nursing home, a hospital or at home. And it counsels that patients can "gain control" about how they die by discussing those end-of-life issues with family and physicians.

In making its list, Forbes looked at five criteria.

Forty-four percent of the score was based on health-care quality, with data from the Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid Services. State by state, the data, originally published in the Journal of the American Medical Association, examines patient treatment for a variety of diseases. Utah ranked No. 5 in that area.

States were also graded (9 percent of the total) on the quality of what Forbes called "elder law." In that legal protection category, Utah scored a B-. Some states, including Delaware and Maine, ranked much higher, with A-pluses. Vermont had the low score, with a D.

Brown University tracked where cancer patients were likely to die, and that data was used for 22 percent of the score. Utah did well because 40 percent of patients die in either a nursing home or hospital, while 63 percent die at home. The latter is considered by Forbes to be much better. And national studies have long shown that most people, given a choice, prefer to die in their own beds at home, surrounded by loved ones.

Another 22 percent of the total score was based on the percent of Medicare patients who use hospice, end-of-life services in the last year. In Utah, the number is 25 percent; only a handful of states did better than that. The data were gathered by Dartmouth Atlas of Health and were part of the "Means to a Better End" report.

Estate taxes made up the last 4 percent of the survey by Forbes. But because many states are changing their estate tax laws and exemption levels are going to rise, the story cautioned the results are only good for 2005.

Meanwhile, the Wetzels have no doubt they are blessed to be able to let Dick Wetzel die at home, wife Betty said.