In the final stages of life, the decisions about where a loved one should spend their last moments become both deeply personal and profound. The transition from life to death is a delicate journey, and making informed choices about end-of-life care is crucial. One of the most important decisions to consider is whether to have the person die at home or in a hospital. This article will explore the details of this choice, looking at the benefits and drawbacks of dying at home versus a hospital. The goal is to help individuals and families decide the best choice for their unique situation.

When discussing end-of-life decisions, such as whether someone should die at home or in a hospital, it’s important to focus on the person’s values and priorities. These conversations should center around the dying process, using information-based discussions about the expected progression of their medical condition and what type of care will be needed. Having these end-of-life discussions care well before death occurs gives patients knowledge about different care possibilities that they can consider later on. Putting your preferences in writing in an end-of-life care plan will help ensure your wishes will be honored.

People are realizing that where a person dies is a significant aspect of the overall quality of end-of-life care and the quality of death itself. Patients should actively take part in planning their end-of-life care when possible, as research shows that having a say in the type of care provided can greatly influence their well-being.

 

Pros and Cons of Dying at Home:

Providing end-of-life care at home has gained significant traction in recent years, highlighting the diverse benefits it brings to patients and their families during this delicate period.

Doctors often state that terminally ill patients express three primary reasons for desiring to pass away at home: the comfort of a familiar setting surrounded by loved ones, the preference for a less clinical environment than a healthcare facility, and the wish for personal autonomy in decisions like meal choices and sleep schedules. With the increasing awareness of the advantages offered by hospice programs for end-of-life care, there has been a rise in the number of individuals opting to spend their final moments at home.

Research demonstrates that those who choose to pass away at home typically experience a smoother, more serene transition compared to those who do so in a hospital setting. Based on surveys completed by their family members, those who are dying at home tend to encounter greater peace and similar levels of pain when compared to individuals who pass away in a hospital. Additionally, their family members tend to experience less grief.

If you are uncertain about whether receiving end-of-life care at home aligns with your preferences, there are several aspects to contemplate. This choice necessitates open discussions about personal preferences, access to comprehensive home care services, and the facilitation of family caregiving.

 

Advantages:

During challenging and uncertain times, finding solace in the embrace of familiarity and comfort becomes especially valuable. For individuals facing their final moments, the home environment transforms into a sanctuary that offers physical comfort, emotional support, and a sense of control. Home-based end-of-life care allows patients to exert control over this final chapter. They can shape their experiences, treasure their connections, and create meaningful memories that help ease the transition for themselves and their loved ones.

Choosing to pass away at home empowers patients to maintain control over their environment, routines, and traditions. This level of autonomy can profoundly impact a person’s emotional well-being. By remaining in familiar surroundings, individuals can uphold a sense of normalcy and engage in activities that bring them comfort. This control over their environment can contribute to an overall sense of peace during what could otherwise be an overwhelming period.

Opting for home-based end-of-life care ensures that your loved ones can be present whenever you need them, rather than being constrained by hospital visiting hours. The home environment fosters a level of intimacy and closeness that might be harder to achieve in a clinical setting. This environment encourages more natural interactions, free from the sterility often linked with medical facilities, all while ensuring access to expert medical guidance and symptom management. This not only offers emotional and physical support, but it instills confidence in your care plan, as your loved ones can be with you every step of the way.

Patients who may worry about burdening their families often discover that the opposite is true—family and friends’ presence creates an environment of empathy, understanding, and connection. Family and friends play an active role in providing care, fostering a sense of unity and shared responsibility.

Research indicates that when a person passes away at home, their family members tend to experience less intense grief. This implies that being there during the final moments can help ease some of the emotional pain often linked with losing a loved one. Home-based care offers comfort even after the person has passed. Family members can grieve at their own pace in a familiar environment. They have the flexibility to decide when to reach out for help from emergency services or funeral homes, enabling a more gradual transition into the phase after the death.

 

Challenges:

Home hospice care is not only about medical considerations but also an intricate interplay of emotions, resources, and realities. The use of home hospice care is a decision that often carries unspoken assumptions and expectations, both for patients and their families. Understanding the level of support to be provided is important in making an informed decision about whether to die at home versus in a hospital. These factors can shape the journey that lies ahead.

 

Dispelling Misconceptions:

One of the major misconceptions is the belief that professional hospice care will be an around-the-clock presence in the home environment, but the practical constraints of financial resources and staffing realities often make this unsustainable.

Families embarking on the home hospice journey may think they are mentally prepared, but often, people do not know the realities of caring for a loved one at home at the end of their life. Add to that the physical and emotional demands involved in providing care, caregivers frequently find themselves navigating challenges that are greater than they initially thought.

 

Redefining Expectations:

When contemplating the prospect of home hospice care, having realistic expectations is important. The patient’s medical requirements and safety considerations can easily be greater than the capabilities of family caregivers. Addressing these realities is the first step towards creating an environment that is going to lead to a peaceful home death.

 

Critical Elements for Home Hospice Care:

  • Unified Support: A coordinated effort of the patient’s wishes and the family support system.
  • Shared Caregiving: Acknowledging that the role of caregiver is not meant to be done by one person but shared among a circle of friends and family members.
  • Accessible Medical Expertise: Having skilled medical assistance within reach at any hour can ease anxiety and enhance the quality of care.
  • Medical Infrastructure: Having the necessary medical equipment in the home for end-of-life care.
  • Boundaries of Care: Certain medical interventions, readily accessible within a hospital setting, might be unavailable in a home hospice environment.

 

Pros and Cons of Dying in a Hospital:

Recently, people have questioned the idea that hospitals are where people need to be for end-of-life care. In some cases, there is a push for having a “good death” in the home. Despite the ongoing debate surrounding this matter, it’s necessary to recognize the benefits that hospitals offer during this stage of life.

 

Advantages:

Hospitals offer many benefits that affect patients and their families in important ways. One advantage is having access to advanced medical treatments and expert doctors. Hospitals are equipped to closely monitor patients and quickly respond to emergencies, ensuring their safety and well-being, which is a crucial part of being in a hospital.

For individuals who have dealt with prolonged illnesses, the familiarity of the hospital should be considered when deciding between dying at home or in a hospital. The comfort of the familiar surroundings and staff can ease the difficulties of this tough time. Keeping this consistency might mean ensuring it is possible to stay in the same hospital ward, as medical needs change and shifts are common.

Beyond medical treatment, hospitals also address the emotional and psychological needs of patients. This dedication is evident through specialized palliative care units within hospitals. These units have the expertise to effectively manage pain and provide compassionate emotional support to both patients and their families. Another important advantage is the team of skilled medical and nursing professionals in hospitals. They address physical symptoms and offer assistance for the emotional toll that this phase of life brings, ensuring comprehensive and holistic care.

Hospitals also provide around-the-clock care, creating a place of 24/7 attention that guarantees consistent supervision and aid. This is particularly crucial during critical stages of illnesses. For caregivers, hospitals offer a much-needed break. The ability to step back at the end of the day and find comfort at home is a valuable benefit. However, this choice comes with the challenge of leaving their loved ones in the hospital’s care, adding to the difficulty of the decision.

 

Challenges:

Navigating the complex world of end-of-life care involves dealing with the different sides of hospital environments. Hospitals are crucial for medical treatment but often lack the cozy feeling of home. Instead, they have a clinical vibe that might feel uncomfortable. Bringing special items from home is worth considering to create a more caring atmosphere. Having the chance to bring in things like favorite blankets and meaningful photos into the hospital can turn it from a clinical place into a more cozy and comforting space for patients, caregivers, and family and friends.

Hospitals have strict routines that can unintentionally take away control from patients and families. This can be hard because it challenges their independence. Also, privacy is a big concern in hospitals. It is difficult for families to have personal moments and connect with each other when the hospital is busy and crowded.

End-of-life care can be complicated, especially in a hospital that might seem unfamiliar and chaotic. This kind of setting can make people feel anxious and uneasy, especially those with dementia. This can lead to not-so-good outcomes for people at the end of their lives. The mismatch between what hospitals are like and what people with dementia need makes things even more complicated.

In end-of-life care, medical treatments are sometimes made without considering what the person wants. Hospitals might do treatments like CPR and IVs, even if the person does not want them in their final days. In these situations, it is important for the healthcare team to work closely with patients to make plans that match their wishes.

Effective communication and planning within a hospital setting can significantly enhance the experience of end-of-life care. People can create an advanced care directive, which helps them keep control over their medical decisions and ensures that their preferences are known to everyone involved in their care, including family, friends, and caregivers. Discussing your end-of-life wishes, while challenging, is essential.

 

Tips on how to decide what is right for you:

The choice of a hospital or home setting for end-of-life care can vary based on different family perspectives. Some families may prefer not to remain in a house where the person has died, while others find solace in the idea of their loved one dying in familiar surroundings. Ultimately, the decision between dying at home versus in a hospital is complex and deeply personal, considering medical factors, emotional well-being, and cultural beliefs.

The research underscores the significance of considering your personal preferences and feelings about end-of-life care. This is particularly crucial for individuals with dementia. Initiating conversations about these matters early on, before dementia advances or added health challenges arise, is best.

Conversations with your loved ones and medical professionals about your care are part of planning for your future treatment, ensuring understanding and collaboration for the best decisions. Honest talks are critical to help others understand and respect your end-of-life care wishes. Deciding on end-of-life care should involve you, your family, and your doctors working together. Creating an end-of-life care plan, having advance directives, and choosing a medical decision-maker are proactive steps ensuring your preferences are honored, even if you can’t communicate.

There are organizations and people, such as death doulas, that are offering skilled counseling and information that help in guiding these conversations and helping families through the process of putting their end-of-life care plan into writing so that their loved ones and medical professionals know their wishes.

 

Several essential factors should influence the decision-making process:

  • Patient’s Medical Condition: The patient’s health status and medical needs play a crucial role in deciding the most suitable care setting.
  • Personal Preferences and Values: The patient’s personal beliefs, values, and desires for their final moments should guide the decision.
  • Family Dynamics and Caregiver Capabilities: The availability and willingness of family members to provide care and support are significant considerations.
  • Emotional and Psychological Considerations: Emotional well-being, psychological comfort, and the emotional toll on patients and families must be considered.
  • Financial Implications: The financial aspect of end-of-life care, including potential costs associated with home care or hospital stays, should be considered.

 

Questions to think about when making the decision:

Does your family have the financial resources to support a home death?

Is your home set up, or is it able to be set up for end-of-life care? For example, is there a bedroom on the main floor or somewhere that a hospital bed can be placed?

Is there enough room in the home for medical equipment that would help in providing care?

Can caregivers afford to take time off work, or are they eligible for caregiver benefits?

Can the patient perform some tasks, such as transferring to a toilet or holding a spoon for eating, or does the caregiver need to help with all tasks?

If the patient is having physical symptoms, like pain or trouble breathing, has the caregiver been provided with the needed resources and information to make the patient comfortable?

Is the family comfortable with healthcare providers coming into the home to help with caregiving? Home care workers, palliative care nurses, or doctors may be some of the people who visit the home.

 

Can you change your plan?

You can decide at any stage to change your mind about staying at home or going to a hospital and exploring other options. Sometimes, people go into a hospice or hospital to manage symptoms, give their caregivers a break (respite), and then return home. Or they may decide it’s not possible to stay at home, even with home help, and that they would be more comfortable in a palliative care unit or hospital. The important thing to remember is that you can change your mind.

 

Conclusion:

Choosing between dying at home versus in a hospital is a deeply personal decision that requires careful thought. By understanding the pros and cons of each choice, you and your family can make well-informed decisions that focus on comfort, respect, and emotional assistance. The preferred care choice should mirror your desires, values, and unique situation, ensuring a peaceful and meaningful transition from life to after.

The goal is always to provide comfort, skilled medical care, and emotional support during this challenging and sensitive life phase.

Whether it’s dying at home or in a hospital, each choice has its own advantages and challenges, demanding thoughtful consideration. Ultimately, this decision impacts not just those nearing the end of life but also the strong support systems around them. The conversation about end-of-life care covers not only medical factors but also the intricate interplay of feelings, preferences, and the pursuit of a dignified final chapter.

Seeking support and information is crucial to selecting the best choice for your loved one and family. Rothkoff Law Group has professionals available with the tools to help you with advanced care planning and end-of-life care planning. Call today to see how we can help you plan for the end of your life.