Experiences with home hospice care: Determinants of place of death

Abstract

During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.     

Experiences with home hospice care: Determinants of place of death

During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.     

Determinants of the place of death among terminally ill cancer patients under home hospice care in Japan

Although the place of death of patients with terminal cancer is influenced by multiple factors, few studies have systematically investigated its determinants. The purpose of this study was to examine the influence of the patients' sociodemographic, clinical and support network variables on the place of death of terminally ill cancer patients under the care of home care agencies in Japan. Among 528 patients from 259 home care agencies, 342 (65%) died at home and 186 (35%) died at a hospital. From the multivariate logistic regression model, patients who expressed the desire for receiving home care at referral [odds ratio (OR), 95% confidence interval (CI): 2.19, 1.09-4.40] in addition to the family caregiver's desire for the same (OR, 95%CI: 3.19, 1.75-5.81), who had more than one family caregiver (OR, 95%CI: 2.28, 1.05-4.94), who had the support of their family physician (OR, 95%CI: 2.23, 1.21-4.08), who were never rehospitalized (OR, 95%CI: 0.04, 0.02-0.07), who received more home visits by the home hospice nurse during the stable phase under home hospice care (OR, 95%CI: 1.25, 1.02-1.53), and who were in the greatest functionally dependent status during the last week prior to death (OR, 95%CI: 8.60, 4.97-14.89) were more likely to die at home. Overall, this model could accurately classify 95% of the places of death, which is higher than other published studies. A clearer understanding of factors that might influence the place of death of terminally ill cancer patients would allow healthcare professionals to modify healthcare systems and tailor effective interventions to help patients die at their place of preference.     

Preference of place for end-of-life cancer care and death among bereaved Japanese families who experienced home hospice care and death of a loved one

Purpose  

The aim of this study was to clarify factors related to the preference of place for end-of-life cancer care and death, from the perspective of the bereaved family.     

Mobile health technology and home hospice care: promise and pitfalls

With the increasing use of mobile devices (e.g., smart phones, tablets) in our everyday lives, people have the ability to communicate and share information faster than ever before. This has led to the development of promising applications aimed at improving health and healthcare delivery for those with limited access. Hospice care, which is commonly provided at home, may particularly benefit from the use of this technology platform. This commentary outlines several potential benefits and pitfalls of incorporating mobile health (mHealth) applications into existing home hospice care while highlighting some of the relevant telemedicine work being done in the palliative and End-of-Life care fields.     

Webcasting in home and hospice care services: virtual communication in home care

The access to free live webcasting over home computers was much more available in 2007, when three military leaders from West Point, with the purpose of helping military personnel stay connected with their families when deployed, developed Ustream.tv. There are many types of Web-based video streaming applications. This article describes Ustream, a free and effective communication tool to virtually connect staff. There are many features in Ustream, but the most useful for home care and hospice service providers is its ability to broadcast sound and video to anyone with a broadband Internet connection, a chat room for users to interact during a presentation, and the ability to have a "co-host" or second person also broadcast simultaneously. Agencies that provide community-based services in the home will benefit from integration of Web-based video streaming into their communication strategy.     

Caregiver bereavement outcome: relationship with hospice at home, satisfaction with care, and home death

This study used a randomized controlled trial design to investigate the impact of hospice at home (HAH) on caregiver bereavement outcome. Secondary analyses considered the association between bereavement, place of death, and carers' assessment of support. Ninety-six informal carers of patients referred to HAH were surveyed six weeks post-bereavement about the quality of terminal care. Carers next completed measures of their own bereavement response and general health six months post-bereavement. There was no evidence that HAH had an impact on bereavement outcome. In contrast, perceptions of inadequate terminal support and high symptom severity were associated with worse carer bereavement response. However, it remains unclear whether carers' retrospective ratings constitute an accurate account of symptoms and care. Home deaths were associated with both better bereavement response and better physical health post-bereavement than were inpatient deaths. Further research is needed to investigate the implications of death at home for the carer.     

Creative forces for retention of home health aides in hospice and palliative care

Qualities of character and physical capability are essential for the success of a home health aide. The aide needs to be prepared by the organization to provide expert care in various home settings, with patients and families whose personalities, lifestyles, ages, cultural background, and socioeconomic status may be vastly different from those the aide has experienced. This article explores the history of home health aide services as a backdrop to understanding the creative forces in recruitment and education methods, as well as support and team efforts that contribute to having successful careers as aides in the home care setting.     

A report on location of death in paediatric palliative care between home, hospice and hospital

This retrospective study analysed data for 703 children who died from 2000 to 2006 to examine where children with a broad range of progressive, life-limiting illnesses actually die when families are able to access hospital, paediatric hospice facility and care at home. There was an overall even distribution for location of death in which 35.1% of children died at home, 32.1% died in a paediatric hospice facility, 31.9% in hospital and 0.9% at another location. Previous research suggests a preference for home as the location of death, but these studies have primarily focused on adults, children with cancer or settings without paediatric hospice facilities available as an option. Our results suggest that the choice of families for end-of-life care is equally divided amongst all three options. Given the increasing numbers of children's hospices worldwide, these findings are important for clinicians, care managers and researchers who plan, provide and evaluate the care of children with life-limiting illness.     

The meaning of home: how it shapes the practice of home and hospice care

Nurses often hear clients and their families express a strong desire to "go home" from the hospital or nursing home. The purpose of this article is to explore what they mean when they make this request and how this meaning of home can shape the practice of home and hospice care. To do this, definitions of home and a health-at-home model are described and applied through a case study.