HOME CARE: Few Elderly Receiving Home Care Die At Home
Fewer than one-fourth of elderly patients receiving community- based long term home care actually die at home, according to a study in the current issue of the Journal of the American Geriatrics Society. In an effort to address the "ongoing debate as to which sites of end-of-life care -- home, hospital, or hospice -- best suit the needs of patients," researchers from Yale University School of Medicine and VA Connecticut Health System and Yale University analyzed the death sites of 620 elderly patients. Among the group of patients admitted to Connecticut's Community-Based Services program and receiving home care between 1989 and 1990, only 21% died at home; 49% died in a hospital, 20% in a nursing home and 7% in an inpatient hospice. Dr. Terri Fried and colleagues found that characteristics associated with dying at home were "poor physical and cognitive function, female gender, living with a child," and "cancer, chronic lung disease, and coronary artery disease as a cause of death." While longer lengths of home care "might have been expected" to correlate with home deaths as "patients and their families became more accustomed to receiving home care services," the findings actually indicate the opposite: longer time in the home-care program was associated with fewer home deaths. Indeed, the study found that for patients receiving home care from 237 to 363 days, 27% died at home, compared to 38% of patients receiving home care for under 65 days. The authors conclude that low rate of home death "appears to support the assertion that 'it is unlikely that we will, as a society, decide to take our dying elders back into our homes" (1/99 issue).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.