Patients, Families Overwhelmingly Prefer the Home as End-of-Life Setting, Researchers Find

McKnight’s Home Care | By Adam Healy
 
Patients and family members alike prefer the home over any other care setting for end-of-life care, researchers discovered in a review of more than 200 studies.
 
An analysis of all 229 studies found that as many as 89% of patients and 84% of family members prefer end-of-life care to be delivered in the home. The home is also the most preferred place of death, with more than half of patients indicating as such.
“There was consistency that home is the most favored place for EOLC [end-of-life-care] and death, both for patients and their families,” the researchers wrote in the review published by the Journal of Pain and Symptom Management.
 
Patients preferred to receive care in the home for a variety of reasons. Many reported feeling a sense of autonomy, dignity or peace at home, noting benefits such as being surrounded by family and friends. Caregivers, meanwhile, preferred patients experience end-of-life care in the home because many felt it respected the patient’s wishes and made their role as a caregiver more meaningful.
 
The Centers for Medicare & Medicaid Services has experimented with payment models that help keep end-of-life patients comfortably in their homes. A recent review of the Medicare Care Choices Model found that participants were able to spend up to five more days at home compared to those who were not involved with the program.
 
Still, a minority of patients and caregivers also indicated that they prefer other settings, such as hospitals, nursing homes or other facilities, for receiving care at the end of life. Some felt that clinical settings could provide better care, especially when the patient’s condition is especially acute. Home-based end-of-life care may also increase caregiver’s burden, or make it harder to connect with support when care is needed urgently.
 
And others may have no choice as to the setting in which they can receive care. Rural patients in particular might not have access to local providers, or resources to support home-based hospice or palliative care, which might affect some people’s decision-making.
“Some patients decide to sacrifice their preferences and move to another place, commonly to hospitals and hospice/palliative care facilities,” the researchers wrote. 
“However, these care facilities are not available everywhere, especially in remote or rural areas, and the lack of support at home is critical to the decision.”