Americans are increasingly dying at home, instead of in a hospital or long-term care facility. In a recent study in the New England Journal of Medicine, researchers found that 30.7% of U.S. deaths by natural causes occurred at home. Many people, when thinking about the end of their life, feel they would prefer to die in their familiar home, surrounded by loved ones.
Health and support service providers work with individuals nearing the end of life and their families to help them understand options for care, including palliative and hospice care, and to make sure that the goals and values of the individual and family are understood and respected. Both palliative care and hospice care can be incorporated for individuals who include dying at home in their end-of-life goals.
Hospice & Palliative Care
There is some overlap in the services provided through palliative care and hospice care, and many people remain unclear about the distinction between the two. Palliative care is a type of specialty care provided to individuals living with serious illness. It focuses on providing relief from symptoms, increasing comfort, and improving quality of life for individuals and their families. Palliative care includes clinical care such as symptom management, expert communication about disease trajectory and what to expect, and coordination of care across health care providers and settings. Palliative care can take place at home, but is not always associated with end-of-life care.
Hospice care, like palliative care, also focuses on providing comfort, relieving symptoms, coordinating care, and improving quality of living for people with serious illness. Unlike with palliative care, however, in hospice care curative treatments are stopped. Hospice care is for individuals nearing the end of life—usually for those expected to live for less than six months, though hospice can be provided for any individual with a life-limiting illness. Some people choose to have hospice care at home, while others experience it in designated care settings.
Things to Consider
While there are many good reasons for wanting to die at home, some health care providers caution that there are complicated considerations when making this choice. Some families might prefer the consistency and reliability of around-the-clock care they can receive in a hospital or skilled nursing setting. Hospice care generally does not include continuous care, and family members provide much of the direct care at the end of life. Some may find it logistically and emotionally difficult to provide hands-on care for a loved one.
It is most important to ensure that individuals and families can access quality care in all settings. This includes care that promotes quality of living throughout an illness, and that also focuses on discussing, understanding, and honoring patients’ and their caregivers’ wishes for end of life care.
The NCIOM Task Force on Serious Illness Care examined many issues related to end-of-life care, including the importance of patients, families, and health care providers understanding the many considerations when identifying preferences at end of life. Task Force recommendations include:
Look out for the final Task Force report and recommendations, to be released spring 2020.