Hospital, Hospice or Home?
Choosing Where to Spend Your Final Days.
By Dr. Ian Warrack
Caring for someone at home during their final days of life is not for all of us. It can be emotionally (and financially) draining, difficult work. So why do so many of us prefer to spend our last days at home, surrounded by the people we love in the comfort of our own home?
Here are three short stories I’d like to share.
“BD” was admitted to hospital and found to have advanced cancer. As soon as he heard that, he asked to be discharged so he could die at home, in familiar surroundings and with his family. Thanks to his palliative care team, his family was fully supported as BD passed away comfortably less than two weeks after BD was sent home.
“MK” chose to die at home after living with prostate cancer for several years. Although his wife had some anxieties about it, she agreed. The family received a lot of help from visiting palliative care nurses and me, his family physician. After MK died, his wife confided to me that she had felt at ease during his last weeks and that spending his time at home had been the right decision.
“LT” lived in a rural area. He had cancer for a few years but refused treatment of any kind. He wanted to die at home. His wife was in agreement. As his family physician I worked with a palliative care nurse, my patient and his wife, giving him his final wish of a peaceful death in his own home.
When faced with end of life care decisions, Canadians have three choices; hospital, hospice or home.
Hospitals have a finite number of specifically designated palliative care unit beds. However, most patients are admitted to the hospital’s regular acute care beds. The environment is very clinical and so, for most, hospital is not the preferred place to die.
Hospices are usually at capacity. In 2015, there were about two dozen residential hospices in Ontario, with about 300 beds. Even though the provincial government committed to increasing the number of hospice beds, the number of end-of-life palliative care patients far exceeds the capacity of hospices.
Canadians are getting older. More than 20% of us are over 65 and almost three quarters of all deaths occur in that age group. Cancer accounts for 30% of those deaths and that number is rising.
Home is Where Your Heart Is
Home is your sanctuary. This is where the majority of patients would prefer to die, in familiar surroundings, supported by family, friends and loved ones.
However, some patients don’t want to “burden’ their family with caring for them at end-of-life. Family members can be reluctant to have their loved one die at home due to their anxiety of providing care during the end-of-life process.
Most of these challenges can be overcome by the support of multidisciplinary care teams that may include physicians and nurses, social workers, mental health professionals, dietitians and other healthcare professionals.
Although I’m a retired physician, I have everlasting memories of my patients BD, LK and MT as they passed away surrounded by the people they love in a warm and loving environment.
The OutCare Foundation is taking a bold step forward by focussing its energy on helping more families embrace the opportunity of caring for a loved one during their final days in the comfort of home.
There are choices at end-of-life and I’m proud to be part of an organization that helps families chose home as their final resting place.
About the author: Dr Ian Warrack, is a retired family physician who practiced in Canada for 49 years. Dr Warrack provided palliative care in a variety of non-hospital settings until he retired in 2017. He joined the OutCare Foundation board in 2012 with a strong belief that palliative care should be available in whichever setting the patient wishes – including their own home.