A national survey that studied the care for dying Americans gave Iowa low grades in many areas, but an expert working on the issue says you can’t judge progress by the report card. Tanya Uden-Holman of the University of Iowa says some of the data in the report by the “Last Acts” organization is dated, and Iowa has made progress in many areas. An example is Iowa’s “C” grade for helping patients manage pain in the later stages of their life. Uden-Holman says an Iowa coalition has developed a pain management handbook. She says the manual has been distributed across the state and they’ve also offered training in pain management. Uden-Holman says a new law regarding orders signed by patients who don’t want to be resuscitated was signed into law in April. She says changing the way Iowa deals with its dying residents takes time. She says Iowa faces lots of challenges as a rural state, but she says progress is being made and the report should act as a springboard in getting more activities going. The national report says all states need to improve in the way they help Americans at the end of their lives.