Please Note: This blog addresses the very serious yet sensitive topic of end-of-life care. While the subject is important to learn about, we wanted our readers to be aware of the contents before they began reading.

For many people, their home is their castle. While they might stay in hotels for business or a fancy resort for vacation, they still enjoy returning home. It’s comfortable, and they tend to be more relaxed. It’s also a place of refuge and safety, where they are free to be themselves, after a long day at the office or on the road.

Nobody wants to go to the hospital (except maybe to deliver a baby), but those who are ill typically understand and accept the need for a hospital stay when the situation warrants it. However, even sick patients often prefer to recuperate at home—where it’s quieter, more familiar, and full of happy memories and functionality that can aid recovery.

When the illness is serious enough to require regular treatments, or the diagnosis is terminal, patients and their loved ones are faced with difficult choices. While home might be the most comfortable place, the hospital or hospice facility might offer better access to round-the-clock care.

There are many factors to think about when making this important (and often heart-rending) decision, but let’s look at three primary considerations when contemplating hospital, hospice, or homecare:

1. What does the patient want?

2. How can we best extend the patient’s life?

3. How can we ensure quality of life for the patient?

Research Available End-of-Life Care Options

Before we examine these three questions, let’s define what we mean by “hospital,” “hospice,” and “homecare.”

When do patients need to be in a hospital?

● Usually temporary stays where the medical team determines the length of the stay and treatments for the duration.

● Usually the best method for acute situations like emergency care, surgeries, or diagnostic tests.

● According to the Agency for Healthcare Research and Quality, in 2018, there were 143.5 million emergency room visits, and only 14% of those visits resulted in hospital admission.

● According to the CDC, the most frequent reasons for hospitalization are “septicemia, heart failure, osteoarthritis, pneumonia, and diabetes mellitus.”

● The average length of stay for a hospitalization is 5.5 days, and a “long stay” is any stay over 30 days.

When should we start thinking about hospice?

● The maximum length of stay in a hospice facility is 6 months, because patients aren’t expected to recover once they enter hospice. In other words, the patient is expected to pass before they reach the 6-month mark.

● It’s a common misconception that hospice is only for patients who have a few days or weeks to live. Again, anyone whose illness limits their life to 6 months or fewer can be assessed for hospice.

● There are 3 distinct stages of hospice care: evaluation, comfort care, and end-of-life care.

● Hospice does not automatically mean expensive. In fact, hospice care is covered by Medicare, Medicaid, and many private health insurance plans. Hospice benefits can include the following for qualifying diagnoses:

○ Medications for pain, nausea, anxiety, and depression

○ Commode

○ Hospital bed

○ Oxygen

○ Walker

○ Wheelchair

○ Incontinence products

● Hospice doesn’t just tend to physical needs; a care team is formed to meet the mental, emotional, and spiritual needs too. Team members may include a nurse, social worker, certified nursing assistant, chaplain and grief counselor.

● Although most hospice facilities do an excellent job and are always professional in the way they provide comfort and relief for patients, it’s important to ask them before admittance how much time they spend with patients, how they handle end-of-life decisions, and the scope of services they provide.

The Difference Between Hospice and Home Health Care

One thing to remember is that “hospice” is not a place as much as it’s a type of care. Many people choose a hospice facility, but hospice care can also be provided at assisted living residences and in private homes. The key is for the patient’s wishes to be followed; for quality, compassionate, safe care to be provided; and for the patient’s last days to be filled with palliative comfort instead of worry or pain.

Generally, people recover better at home because that environment is more familiar and comfortable than a hospital or other inpatient facility. For starters, there aren’t as many proddings, pokings, vitals-takings, and beeping! For a lot of patients, the ability to control their daily routines and surroundings aids their recovery process. In this application of the term “home health care,” the patient is expected to recover (and the medical team has approved the release from the hospital).

In this blog, when we talk about “home care,” we’re not talking about “home health” as a viable alternative to hospitalization during recovery. Rather, we’re talking about end-of-life care that takes place at home. In this sense, hospice can still be involved—just at home, where the patient feels more at ease—than in a facility of some kind.

Because few home health care providers are able to provide 24 hours of skilled care each day (and few patients can afford such services), home health care is a good choice for patients with advanced illness who no longer have any curative medical options but are still able to function enough to be at home with their family or a caregiver. These patients will be those whose doctors have estimated that more time remains, not those who only have weeks or days left.

What Matters Most to Patients at End-of-Life?

What matters most to a patient will depend on which patient you ask. Every person is unique, and each medical situation is different. One key is to have these conversations when people are healthy, cognizant, and able to fully understand and answer the questions. Stanford Medicine offered a workshop on advance planning called “What Matters Most” and provided a slide deck that might help navigate these tough topics.

For now, let’s address the three questions we opened with, since research shows that these general factors are most meaningful when it comes to a person’s final days.

1. What does the patient want? According to Lauge Sokol-Hessner, MD, and an article he wrote for the Institute for Healthcare Improvement, The only way to know what is right for a given patient is to ask them. And it can’t be a general question that only solicits vague answers. Be specific: What’s most important to you as you think about how you want to live at the end of your life? What do you value most? Furthermore, it’s not enough to ask only once. A patient’s answer is likely to change as the illness progresses—whether that means a decrease in bodily functions or an increase in pain.

2. How can we best extend the patient’s life? We must be careful here to avoid making decisions out of our own desire for the patient to remain with us instead of doing what’s in the patient’s best interest. If the patient is immobile, unconscious, incoherent, or in a lot of pain, making them endure those conditions even longer could be cruel rather than kind. For some people, living the rest of their lives incontinent or without the ability to recognize anyone is tortuous and not something they would want their loved ones to labor or pay to extend. On the other hand, if there are methods that allow for extra time and the patient agrees to these means, then medical services, devices, and equipment that extend life should be sought.

3. How can we ensure quality of life for the patient? Then again, only seek medical services, devices, and equipment that improve or maintain the patient’s quality of life. This means comfort, safety, and functionality should be at the top of the list. Not all medical equipment is created equal. Opt for premium products that make patients’ final moments on earth something you—and they—can feel good about.

Patients Should Feel Supported—to the Very End

Proper medical seating can make a profound difference in end-of-life home care. When comfort is at a premium, go with a premium product—like the Harmony from Champion.

With a cozy aesthetic that complements any decor, the Harmony comes with a traditional push-back recline, left-side table, and pedestal feet. Casters are also available as a customizable option.

The Harmony is commonly used in extended care, long-term care, and residential home therapy settings. It can also provide comfort, safety, and functionality to those who choose to spend their final days in the home that has meant so much to them during their life.

For more information, contact us to learn how our products and accessories can help make the lives of your caregivers and patients easier, even at the end.