More visits from hospice may allow death at home

NEW YORK (Reuters Health) - Very ill patients who prefer to die at home are more likely to do so if they get frequent visits from hospice nurses and doctors, according to a new report.

The findings highlight the importance of hospices, which provide specialized care to very sick or terminally ill patients and offer them the opportunity to remain at home if they want to.

“Frankly, it’s one of the things hospices offer that hospitals can’t,” said Dr. David Casarett, chief medical officer at the Penn-Wissahickon Hospice at the University of Pennsylvania in Philadelphia.

“People want to be home,” he told Reuters Health. “That’s where they feel comfortable and it’s a matter of dignity.”

In the Journal of Clinical Oncology, Casarett and his colleagues write that the majority of cancer patients die in a hospital even though most would prefer to do so at home.

“Most people now have an option, so it’s really important for people to achieve that option,” said Donna Wilson, a professor at the University of Alberta in Canada, who was not involved with the new study.

More and more people in developed countries are dying at home compared with in the 1990s and 2000s, when the rate of dying in hospitals peaked among terminally ill patients, said Wilson.

She told Reuters Health that, at least in Canada, people moved away from dying at hospitals partly because they were afraid of the aggressive tests and treatments. At the same time, the availability of hospice and pain management services increased.

“A study like this can really be very helpful to waking people up to what we should do,” said Wilson, who added that there will be more dramatic shifts in home deaths as baby boomers continue to age.

“I think people want to spend time at home and we need a health care system that allows them to do it,” added Casarett.


To see what factors were linked to a person’s chance of dying at home, Casarett and his colleagues looked at information collected between October 2008 and June 2011 for cancer patients in hospices in Florida, Pennsylvania and Wisconsin.

From the patients’ medical records, the researchers knew where more than 5,800 of them wanted to die. About three-quarters wanted to die at home, whereas the rest typically preferred to die at a nursing home, a hospice unit or a hospital.

Of the people who started care at home and said they wanted to die there, 1,735, or 55 percent, did so.

The researchers found three factors that were tied to people’s chance of dying at home. Specifically, married people and those who had made their preference clear in advance directives were more likely to die at home. The same was true for people who had daily visits from the hospice for the first four days of their care.

The results don’t necessarily prove that frequent visits by themselves up the chances of dying according to one’s preferences, but the researchers felt that was likely.

“The main finding for us was the issue of being able to show that more visits really do help,” said Casarett. “It’s not really rocket science - it’s common sense in a way. But, from a policy perspective, it’s important.”

That’s because they help hospices that struggle for funding make their case.

The researchers caution, however, that some of the patients in the study may have changed their mind on where they wanted to die after they were asked at the beginning of their hospice care.

Hospice care varies in price, but may be covered by Medicare, Medicaid and private insurances.

SOURCE: Journal of Clinical Oncology, online June 25, 2012.