Home care and end-of-life hospital admissions: a retrospective interview study

Background: Enabling death at home remains an important priority in end-of-life care policy. However, nearly half of all deaths occur instead in hospital, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment where the needs of dying patients are not sufficiently met. Aim: To understand problems in professional and lay care provision which discourage death at home and lead to hospital admissions at the end of life using healthcare staff and family carer accounts. Design and Setting: Qualitative study of admission to a large English hospital of patients (case-patients) close to the end-of-life. Method: Retrospective in-depth semi-structured interviews with healthcare professionals (n=30) and next-of-kin (n=3) involved in an admission. Case-patients (n=9) had died within three days of admission, were aged over 65 and had had either cancer, chronic obstructive pulmonary disease or dementia. Interviews were transcribed and analysed thematically. Results: Home-based end-of-life care appeared precarious. Hospital admission was considered by healthcare staff when there was insufficient nursing provision, or where family support was challenged. In these circumstances, home was not recognised to be a suitable place of care or death, justifying seeking alternative care provision elsewhere. Conclusion: End-of-life care at home often required substantial input from family and professional carers. Where this care was insufficient to meet the needs of patients, home was no longer deemed to be desirable by healthcare staff and hospital care was sought. Keywords: end-of-life care; home palliative care; hospital admissionsThis paper presents independent research part funded by the National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care (NIHR CLAHRC) Cambridge and Peterborough (grant number RG55908), and NIHR CLAHRC East of England (grant number RG74481). The writing of the paper was funded by the NIHR School for Primary Care Research (NIHR SPCR) (grant number RG85520 (NIHR SPCR-2016-S67)). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The Marie Curie Design to Care programme is a service improvement programme. This research forms part of the design phase of this programme (grant number RG87570), which is funded by Marie Curie, the UK’s leading charity caring for people living with any terminal illness and their families