Is it always better to die at home?

  1. I recently lost two patients. One to cancer and the other to COPD. It was known they were dying, and still, they would be sent to the ER with exacerbation of symptoms and neither of my patients came home this last time.

    I was talking to a nurse who doesn't really think it is always such a good thing for the patient to die at home, as this can create more stress and isolated feelings for the family.

    I know, of course, it depends on the family, but in general, what do you believe?

    I'm not so sure I want to die at home, after the discussion we had. Maybe she is right?
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  2. 49 Comments

  3. by   augigi
    I don't think it's about the family at that point - wherever the patient wants to die, that's the best place.
  4. by   BSNtobe2009
    I think it depends on the person and the situation. Some people just get worn down with the illness and just want to go home, get on meds, and visit with family and friends until the end.

    Some people have a huge fear that something might happen to them and if they were in the hospital, it might buy them a few more days, weeks, etc. Even worse, they worry about being in extreme pain and relief not being close by.

    It also depends on the family....how dedicated are they? Have they been worn down as well? Does the family really and truly care?

    That is a hard, hard question.
  5. by   llg
    My mother died a few years ago after a 10-month illness. It was never her hope or plan to die at home. It just wasn't/isn't a part of my family's culture. She didn't want her husband (She had recently re-married when she became ill.) to have to provide personnal care for her and she knew that trying to hire a good round-the-clock caregiver would be problematic, if not impossible.

    My mother also viewed the hospital and the nursing home in which she died as the "best places to be when you are sick." When she was younger and had to be hospitalized a couple of times, she always said she felt better the moment she entered the hospital, just knowing that everything and everyone she needed for her care was right there, ready to help her. She felt that, in the hospital, she didn't have to "be brave" or "strong" for her family's sake. She could just lie back and relax and let the professionals take care of her.

    My parents chose to live in a retirement community that included a top notch nursing home in the years leading up to their deaths and felt good about having made all those decisions and arrangements for themselves. So when it was time for Mom to go from her home to the hospital ... and then to the nursing home a few days later ... she was implementing the plan she had made years before.

    I guess a lot depends on how you view your local institutions and the type of care you expect to receive there. My father was a physician -- and Mom had been president of the hospital's auxiliary. She viewed the hospital as a positive place full of caring people who had taken good care of her and her family in the past. She had similar feelings about the nursing home: it was part of her community and she was extremely familiar with it. She knew she would be well cared for.

    For her, receiving care from those facilities as death approached was a natural progression of her illness -- not a rejection or lack of committment from her family. It's where she wanted to die.

    By the way, my father chose to die by consenting to surgery that he knew he would probably not survive. He didn't want to be an invalid and fade away in the hospital over a period of months. And he didn't want to be sent home to have my mother have to agonize about him having a big heart attack at home. He had been unable to go for more than a week without chest pains and needed continuous meds to stay pain free from the angina. So, he consented to a second bypass surgery and died the next day in the ICU.

    It may not be everyone's choice, but some very knowledgable people have good reasons to choose to die in a hospital or a nursing home.

    Good topic for a thread.
  6. by   llg
    Quote from BSNtobe2009
    I
    It also depends on the family....how dedicated are they? Have they been worn down as well? Does the family really and truly care?

    That is a hard, hard question.
    Just because it is not a family's preference to have it's members die at home doesn't mean that they don't care ... or are worn down ... or are not dedicated. See my post above.

    Some of us don't have the negative views about hospitals or nursing homes that some people have. Some of us are lucky enough to live near institutions that we know and trust and in which we feel safe and cared for. We don't view going there as a bad thing -- but as the best place to be when we need their services.
  7. by   BSNtobe2009
    Quote from llg
    Just because it is not a family's preference to have it's members die at home doesn't mean that they don't care ... or are worn down ... or are not dedicated. See my post above.

    Some of us don't have the negative views about hospitals or nursing homes that some people have. Some of us are lucky enough to live near institutions that we know and trust and in which we feel safe and cared for. We don't view going there as a bad thing -- but as the best place to be when we need their services.
    I never said that.

    The sentence above the one that you copied are directly related.

    If a family member CHOOSES to die at home...then SOMEONE has to take care of them, they can't just be left alone all day, especially if they cannot get up to go to the bathroom, etc....not every family is going to be financially able to do that, not every patient is financially able to hire someone to come in to help. not every family is going to have the emotional capacity to tend to someone day-in, day out.

    The sentence above it said EXACTLY what you said....that some patients PREFER to be in a hospital/assisted living/nursing home because that is where they are comfortable.

    The sentence AFTER it, referred to family members who can't, or won't take care of a loved one.

    Not everyone has the option of living in an assisted living facility because of the expense involved, regardless of their personal wishes. Nursing homes are also not of equal quality every where you go. My parents lived in an extremely rural area and there were only two nursing homes, and the odor would knock you down upon entering either one, and it was well-known that families didn't send their loved ones there....the residents that ended up there usually had no family to stop the process of them getting sent there.

    My father is still alive and my mother died unexpectedly at home. I have no idea of what I would do if his health ever failed because I am the only person he has to care for him, and I am also the only financial supporter of my family. If he fell ill I would bring him to live with me and hopefully there would be enough funds in his accounts to hire someone to come in during the day...but if he required a skilled medical professional for an extensive period of time, there is not enough money there to sustain that for very long and no money to pay for a private nursing facility.

    Not everyone has the same choices or same QUALITY of choices.
  8. by   leslie :-D
    i've given that thought also.
    i've decided (w/my kids being at home) that i would not want to die at home.
    i would prefer a (reputable) facility that has atc care, family accommodations and visiting 24/7.
    not all choose to die at home.

    leslie
  9. by   AnnieOaklyRN
    Like the other posters I think it depends on the family. My step father wanted to die at home, but my mother just could not give him the care he needed so we spent his last few days with him in a hospice house. It was a beutiful place (NOT a nursing home!) and the staff their were wonderful for the most part. They alwasy knew what he needed and what to say in response to questions or feelings. He died peicefully with the assistance of medications to keep him relaxed and with us at his side. I think my mom would have had trouble staying in the house if he had died there, and also we would not have had the 24/7 help of the nurses and aids.

    swtooth
  10. by   nurse4theplanet
    It is an individualized decision based on pt condition/family resources. I would want to die at home, but not if my husband had to quit his job to provide my care, or I had small children watching me go through the process, etc. Very complicated issue. Like almost everything in life, You can't just lump everyone together and say one way is best.
  11. by   nurseangel47
    Just my two cents worth...use to be a hospice nurse. Loved it, too, if anyone on here is considering it. Wish I had stayed in that genre of nursing. Anyway, as far as dying at home versus in hospital?
    I think for the most part I would rather die at home with hospice involved for pain and other symptom management. I would just feel more comfortable I think. If my family had the support of hospice, that is. It is an awesome concept and I think it would work for me and my family.
    But as we all know, everyone and everyone's family and SO are different, and react differently when that time comes. Some are not able to watch as their loved ones are getting ready to pass. Others aren't comfortable with the care and see it as a burden and may genuinely be burdened by the care at home.
    Others may have uncomfortable feelings related to the spirit and / or uncomfortable feelings of knowing that their loved ones spirit left while in the dwelling they are going to continue to live in...ghost memories, memories of life together in the home while the person was alive and then seeing that person die there...might make for poor adjustment after the loved one's death.
    Many factors to deal with and think about. What is best for the patient and the loved one can also become a loggerhead for some.
    I just make sure that I reinforce periodically to my children and SO that I DO want to be made as comfortable as possible at home and want to be in familiar surroundings and have hospice involved in my end of life care.
    I just am not so sure I would be as comfortable in a hospital setting as I would at home WITH PROPER care provided, that is. If they could coordinate cna/tech care for every day maintenance such as hygiene, turning, etc. and then nurse monitoring of pain, secretions, other complications, then yes, I'd rather die in my own bed.
  12. by   Jo Dirt
    Quote from nurseangel47
    Others aren't comfortable with the care and see it as a burden and may genuinely be burdened by the care at home.
    Others may have uncomfortable feelings related to the spirit and / or uncomfortable feelings of knowing that their loved ones spirit left while in the dwelling they are going to continue to live in...ghost memories, memories of life together in the home while the person was alive and then seeing that person die there...might make for poor adjustment after the loved one's death.
    Many factors to deal with and think about. What is best for the patient and the loved one can also become a loggerhead for some.
    These are the reasons I think I would choose to die in a hospital.
  13. by   Sabby_NC
    Hi this is my first post on this awesome website that my husband showed me.
    I have been nursing for over 30 years and have worked in Hospice Care for 3 years. It has to be the most rewarding part of my nursing career. I am originally from Australia but now live in the USA.
    The exorbitant cost in health care will have a bearing on whether these patient’s can be nursed in a short or long term facility OR be nursed in their own home.
    With the support of family, friends, Hospice RN, HHA, Social Worker, Chaplain, Bereavement Counselor, sitters and of course the MD the pts can and are well looked after in the home.
    Situations change and families find they no longer can continue this care so I have found in my Hospice Nursing that I encourage families to have a ‘back up’ plan in case this does indeed happen.
    The whole basis is what the patient desires for their death. It is the hardest thing to watch a loved one go through the dying process and eventual death but given the support and love that a Hospice Organization can offer it can be a precious time in the families life.
    Working in this field I am constantly aware of the pt and families goal for care. This is more important when the pt can no longer express to you due to the active dying process. So always make sure you are aware of their and families goals.
    You are their advocate for their care and they are reliant on you for this.
    From my experience I have found that the percentage of people dying in their home is much higher and for the most part that is their wish.
    So yes I think it is far better to die at home in familiar surroundings and the love of family around you.
  14. by   weetziebat
    I have to agree that I don't think it is always better to die at home. A lot depends on the family situation and their ability to accept and participate in giving good care.

    In a home with lots of conflict, where the patient knows they are only causing more havoc, and knowing family don't really want them there would be terrible.

    Perhaps an in-patient hospice would be better in those cases. Personally, I wouldn't want to die in a hospital, but would far prefer that than to die in a nursing home.

    I my vast six months of hospice experience I haven't heard of anyone who you would feel would have preferred not to die at home. In the right circumstances, it seems like the choice I would want.

    Then again, think I'd prefer to die in my sleep at the ripe ole age of 98. The night after I'd been out partying.

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