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Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care.

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Hoare, Sarah 
Kelly, Michael P 


BACKGROUND: Enabling death at home remains an important priority in end-of-life care policy. However, hospital continues to be a more prevalent place of death than home in the UK, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment, associated with inadequate family care provision and insufficient professional care delivery. AIM: To understand problems in professional and lay care provision that discourage death at home and lead to hospital admissions at the end of life. DESIGN AND SETTING: A qualitative study of admission to a large English hospital of patients close to the end of their life. METHOD: Retrospective in-depth semi-structured interviews with healthcare professionals (n = 30) and next-of-kin (n = 3) involved in an admission. Interviews addressed why older patients (>65 years) close to the end of life are admitted to hospital. 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, which was often extensive but under supported, was challenged. In these circumstances, home was not recognised to be a suitable place of care or death, justifying seeking care provision elsewhere. CONCLUSION: Challenges in home care provision led to hospital admissions. Home end-of-life care depended on substantial input from family and professional carers, both of which were under-resourced. Where either 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.



end of life care, home palliative care, hospitalisation, primary care, Community Health Nursing, Health Services Needs and Demand, Home Care Services, Hospice Care, Hospitalization, Humans, Primary Health Care, Qualitative Research, Retrospective Studies, Secondary Care, Social Support, Terminal Care, Terminally Ill, United Kingdom

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Br J Gen Pract

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Royal College of General Practitioners
National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough Clinical Commissioning Group (CCG)) (unknown)
Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) (unknown)
National Institute for Health Research (NIHR) (via Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) (unknown)
Marie Curie Cancer Care (unknown)
Wellcome Trust (097899/Z/11/Z)
This 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.