CARING FOR DYING PEOPLE IN HOSPITAL

Caring for Dying People in Hospital



Caring for Dying People in Hospital

A Literature Review

The hospice concept includes both home care and inpatient care. Ideally, hospice care represents a continuum that includes both forms of care, beginning with home care and moving to inpatient care when it becomes necessary. However, the major emphasis of hospice treatment is on home care.

Inpatient care usually becomes necessary for one of three reasons. The first is that a stay of a few days in an inpatient facility may be helpful in bringing the patient's pain and other symptoms under control. The second is that the family taking care of the patient at home may become exhausted and need a few days' rest while the patient is cared for elsewhere. The third reason is that home care becomes inappropriate at a given stage of the illness due to the patient's condition or home situation. When a patient is admitted to an inpatient facility, the hope is usually that he or she will be able to move back and forth from home care to inpatient care as needed at various stages of the illness.

Academic Case Studies

Most Americans say they would prefer to die at home. But, as The Dartmouth Atlas of Health Care 1999 reports, depending on where they live, anything from 20% to more than 50% of Americans die in hospital. People are more likely to die in hospital in regions well supplied with hospital beds . The Dartmouth Atlas findings show that

Figure 1

Percentage of Medicare enrollee deaths in hospitals.

We do not know the right number of hospital deaths, and this number may vary depending on the numbers of old people living alone, patterns of illness and financial context. However, since we do know that most American deaths occur in institutions, clinicians must provide good palliative care wherever the patient is. The following case reports illustrate why we need positive, realistic, end-of-life options outside of the home.

Case 1

Mrs P is an 88-year-old widow dying of colon cancer. Her grown children live in other States and cannot visit for extended periods of time. For Mrs P a hospital or subacute unit might be a more supportive environment than her home. Even if she could afford a full-time paid caregiver at home, she is unlikely to have as many different types of social and caregiving contacts at home as she would in a structured caregiving setting such as a nursing home or an impatient hospice programme. Unfortunately most nursing homes are not equipped to provide the intensive sophisticated palliative care services that a terminal cancer patient requires; and inpatient palliative care services or hospices can only serve patients with short life expectancy (a few days to a week). In the USA there is no good option for Mrs P under the current system.

Case 2

Ms A is a 29-year-old single mother dying of AIDS. She has valiantly fought her illness and is not ready to die. Yet when she comes into the hospital with her ...