I am of two minds.  As a hospice doctor I visited a lot of people at home.  I loved making home visits!  The familiar smells of home cooking, the loved but “eclectic” collections of furniture that did not have to be pre-distressed because it was distressed.  The home environment wrapping a dying person into the fold of every day family life.  But I also grew up poor and know what inadequate housing looks like; what living on the edge means on a daily survival basis.

And I know that you can’t have home hospice care if you don’t have a functioning phone.  How will you call the hospice team for help?  You can’t have home hospice if you don’t have electricity. How do you keep the concentrator running?  You can’t have home hospice if the primary care giver is old, sick themselves and there is no one to help.

Then I was introduced to the Dartmouth Health Atlas.  High income zip codes – high in-home death; low income zip code-low in-home deaths.  Benson and colleagues explore with patients and caregivers the struggle to die at home when poorly resourced.  Their findings echoed our experience with opening the Balm of Gilead and Safe Harbor Palliative Care Units in Birmingham, Alabama.  More people could and would use home hospice care as a discharge plan when we included the option of readmission to our Palliative Care Unit when care at home was no longer the best, safest option.

Hear patient and caregiver voices in the link below

Jacquelyn J. Benson et al. The Motivations and Consequences of Dying at Home: Family Caregiver Perspectives, Journal of Housing For the Elderly (2018). 

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