Dying at home – Why is it not always possible even if you want to make it happen?

The outcome for HCA Hospice Care’s home hospice service is – “60% of the patients who wish to pass away at home should be able to do so. And 90% of them should be symptom free at the time of death”. Over the last five years, HCA’s 5 home hospice teams have been able to achieve this outcome ranging from 53-63%, with more than 90% of the patients being symptom free at the time of death.
 
This retrospective study aimed at finding the reasons for patients not being able to pass away at home even if they wished to do so.
 
HCA’s Home Hospice Database was analysed to look at the patient and caregiver demographics, length of stay in the service, number of home visits made, symptom burden and relevant clinical data, place of death, symptom control at the time of death and any other relevant information available.
 
The data revealed that the various reasons for patients not being able to pass away at home included the following:
 

1. Age of the patients – Younger patients tend to die in hospitals.
2. Uncontrolled symptoms – Dyspnoea and Pain being the most common.
3. Rapport and Trust with the home hospice team – At least 4 home visits done by the home hospice team within 4-6 weeks is likely to improve rapport and trust between the patient’s caregivers and home hospice team members.
4. Anxious and unprepared caregivers – Caregivers who are not prepared or accepting of the patient’s deteriorating condition or dying phase are likely to send the dying patient back to the hospital.
5. Proximity to the hospital – Patients who live close to their regular hospitals tend to go back to the hospital more frequently.
6. Patients being protective of their families/caregivers – Patients who believe they do not want to be a burden on their family members or caregivers tend to die outside of their homes even if their wish was to die at home.
7. Cultural reasons – Age-old beliefs, superstitions and fear that value of property goes down with a death in it.

 
The presentation will elaborate on the reasons given above with facts and figures from HCA’s home hospice’s data base.
 
Suggestions will also be made on how the home death rate can be improved for home hospice services which wish to achieve this as one of their outcomes.