Photo by Matthias Zomer

There are many challenges of in-home hospice care for clinicians and patients alike. Through understanding and overcoming these challenges, patients, their loved ones, and clinicians can pave the way to better care with fewer challenges for this specialized care provided in the home.

One of the most favorable opportunities for better care and lower costs available today is the care delivery shift to the home. Many established and new organizations are scaling and launching models to move primary, acute, palliative care and hospice care to the patient’s home. For vulnerable and frail patients, home-based hospice care can eliminate the need for more expensive care in hospitals or being moved to other institutional settings. These challenges of in-home hospice care needs to be addressed today.

There are old and new issues facing the hospice care industry. While home-based hospice care models offer convenience, there are notable challenges and risks to their broader adoption. Below are the three key obstacles to moving end-of-life hospice care to the home and potential solutions to conquering these challenges.

1. Patient Preference. As in-home hospice home-based care grows in acceptance and use, it is essential to consider patient preferences for in-home care versus care in traditional hospice care facility settings. Several factors drive patients’ choice of locations other than the home. For some, receiving in-home hospice care can be the number of strangers coming into the home.  It presents a potential of unwelcome invasion of privacy. Some patients and their family may prefer end of life care being provided in an inpatient hospice facility setting while others may be embarrassed about their living situation to welcome in-home end of life care.

These preferences should not be disregarded nor disrespected. Physicians, or a medical professional, will perform an intake assessment about the patient’s health condition and medical needs. This process includes patients in shared decision-making with family members about whether home-based hospice care is the best choice for them. Also, home-based hospice care programs should have established a facility based hospice unit to facilitate handoffs and accommodate patient’s changing preferences. 

2. Patient Safety. There are distinct differences of in-home hospice care to general caregiving in the home setting. The hospice care coordinator assigned to the patient will review the potential environmental hazards such as sanitation, infection control, and the home’s physical layout. The coordinator will gather all information related to family communications. Hospice nurses provide training and education for family caregivers and patients. In-home hospice entities provide continuous health monitoring and ensure the different needs of patients receiving home-based hospice care are met.

Mitigating and rigorously assessing these risks is vital when moving hospice care to the home. The hospice coordinator will arrange for any specialized equipment like a hospital bed, wheelchair and all medical supplies.  In addition, rigorous training is supplied when it becomes necessary for family members to administer medication. A team of medical and social service personnel are assigned to the family and patient. These considerations are consolidated into any other care. On a systems level, there are consistent standards for measuring best practices and safety at home and sharing data as it related to the care given and care received.

3. Regulatory environment. Home-based hospice care is governed by  stringent government regulations that must be uniformly monitored or applied. When patients enter in-home hospice care their medical condition qualifies them for Medicare. This mandate includes all persons providing hospice care are certified, trained and educated in their specialty field to provide care ensuring patient safety.

The impact of in-home hospice care is on full display in Eleanor Gaccetta’s One Caregiver Journey. If you are a currently providing care in a facility, a hospice care provider or about to become a caregiver, “One Caregiver’s Journey” is a MUST-read. This personal memoir will make you laugh or tug at your heart as the author shares her experiences providing 24/7 care to her mother for 9 ½ years until her mother’s death at age 102. The book is an easy read, honestly written, and provides suggestions and information that all caregivers can utilize. The author wrote the book over a long period, and it is a snapshot of the reality of the stages, changes, and many challenges caregivers face over time. It is a caregiver’s blueprint. Reading this book, you will feel like you are in the author’s living room, and she is telling her story and offering great advice and information.

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