The stories we uncovered in this study demonstrate the difficulty of providing and maintaining care at home. Our case studies exposed the vulnerability of home care for some patients, which can be dependent on stretched professional and lay provision. We were very struck by the huge amount of work we found many carers to be providing, and the significant strain those providing it were under”.
- Dr Sarah Hoare
Family carers and healthcare staff said that hospital admission for patients near the end of their lives became necessary because of insufficient nursing and support at home, in a newly published study from the Cambridge Palliative and End of Life Care Group at the Primary Care Unit, University of Cambridge. The study was carried out by Dr Sarah Hoare with Professor Mike Kelly and Dr Stephen Barclay.
In the UK, many people nearing the end of their lives are moved to hospital to die. In fact, nearly half of all deaths occur in hospital. Yet, enabling death at home remains an important priority in UK end-of-life care policy and hospital admissions at the end-of-life are often negatively labelled.
Through in depth interviews with healthcare staff and family carers, this study probes the reasons why people who are cared for at home get moved to hospital in the last days of life. The study exposes a gulf between the nursing and care needs of patients dying at home and the capacity of both professional and family carers to respond.
Healthcare staff and next-of-kin said they believed that dying at home was desirable. But the challenges they encountered in delivering end-of-life care at home countered the desirability of home as a place to deliver end-of-life care and led them to instigate hospital admissions. So hospital admission was sought as a solution, both by healthcare staff and family carers interviewed for the study, when there was insufficient nursing provision available at home, or where family support was challenged or overwhelmed.
The study was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research & Care (CLAHRC) East of England, the NIHR School for Primary Care Research and the Marie Curie Design to Care Programme.