-What are the reasons for elderly patients not dying at home as they desire?

End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients in end-of-life care and in supporting their desires. Support your response with evidence-based literature.

Most people consider home deaths as an outcome of high quality palliative care. The view of the home as the optimal place to die has been challenged, with the establishment of palliative care in hospitals, nursing homes, hospices and other in-patient facilities. Most patients wants die with the presence of their loved ones and be able to enjoy the last few moments with them. For many, not being able to die at home could therefore be seen as a failure in the care given to these patients, even if the patient was actually admitted to e.g. a hospital or hospice for perfectly valid reasons and in accordance with the patient’s wishes. There are many more reasons why most elderly patients prefer to die at home. With the emergence of home health care team, it encourages medical care to be continued at home while enhancing patient’s quality of life with their loved one. According to the article “Where do elderly patient’s prefer to die”, failure to provided death at home was mostly due to a prolonged terminal phase leading to emotional and physical exhaustion in the patient or the family (Groth-Juncker A., 2015).

In accordance to the American Nurses Association(ANA) statement position, it is the nurses duty to provide comprehensive and compassionate end-of-life care . Nurses are obligated to provide care that includes the promotion of comfort, relief of pain and other symptoms, and support for patients, families, and others close to the patient. Throughout this position statement, the term “family” includes those linked by biology or affection; family is whomever the patient says it is (ANA, 2016). In addition, it is also the nurses responsibility to discuss with the physician the patient’s wishes and incorporate social worker and pastoral care.

I currently work in Medical Surgical Oncology unit where I deal with death and dying quite often. There are many cancer patients who wants to die at home rather than at the hospitals, reason being they want to spend their last few days with their family. Most of these patients were offered hospice care, palliative or home health. Although the patient choses one of these care continuum care, it is possible to have it continued at home and they don’t have to stay at the hospital unless they do not have any family, home or anyone whom they can spend their last few moments with.

Comment 2

1-What are the reasons for elderly patients not dying at home as they desire?

Poor communication leading to unwanted care, increase in repeat hospitalizations, increase in late transitions, increase in ICU usage, fee-for-service care attracting financial gain, family members wanting interventions, medicare rules not allowing reimbursement for both skilled nursing facility care and hospice care.

2-Interventions/ activities/ referrals to support your clients in end-of-life care and in supporting their desires

Physicians, patients and the families should discuss end of life option and develop a plan early, Patients should complete an advanced directive and living will clearly stating their end of life choices, Patients should assign a health surrogate that is aware of their wishes, health care facilities need reform, medicare needs reform, patients need earlier referrals to hospice.

3-Evidence-based literature you used?

Nordqvist, C. (2013, February 6). “End-Of-Life Care For Elderly Often Too Aggressive.” Medical News Today. Retrieved from
https://www.medicalnewstoday.com/articles/255991.php.

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