Where to Die: Home, Hospital, or Hospice House?

QUESTION: Talk about dying at home, in the hospital, or in a hospice care facility.

I think it is fair to say that most people, given the choice, would like to die at home, in their own bed, with those people they care about the most close to them, and I’ll even throw in that they’d prefer to have their dog or cat on the bed. That seems like the ideal way to say goodbye.

Today that is the least likely place we die. WHY! Several reasons:
1) Most of us don’t plan ahead for our dying. As the result, those people closest to us, who are left making decisions when we can’t, don’t know what we want.
2) It is hard work to care for the dying, 24/7 work, work for those people who care about us the most and who are therefore the most frightened and tired during this challenging time.
3) Our health care services (insurance, Medicare, Medicaid) do not offer enough comprehensive coverage to address all of the family’s in-home care needs--shift coverage being a big uncovered need.
4) Most of us aren’t given adequate referral time from our medical professionals to get in-home services in place and support given.

Most people die in the hospital setting. To me, there is nothing comforting about a medical setting. There are rules, protocols, procedures, medical interventions, and certainly no dog or cat on the bed (Although I have been known to smuggle in a cat or two, but that is another story). Hopefully family is given privacy, support of Chaplain services if wanted, and ongoing attention and guidance, but it is still a structured environment.

Another place people can die is in Hospice facilities, often called Hospice Houses, which are medical facilities in a home like setting. Staff is trained in end of life care and families have almost total freedom (kitchens to cook in, TV rooms, music room, quiet rooms, sleeping accommodations). A Hospice House is the next best thing to being at home. The family doesn’t have the 24/7 responsibility of care, there is a limit to medical disruption, and you can even bring your own dog or cat.

If you say, “Yes, I want to go to a Hospice House,” there are two catches: time and money. There is a limited time that you can be in a Hospice House under Medicare coverage. About a week or so is the reimbursed amount unless you switch over to private pay. A good number of us do not have the funds required for several months of private pay.

Which brings us back to dying at home. Hospice in-home services are a great help even with their shift limitations. Hospice care provides families with nursing visits; home health aide visits for bathing and bed changes; medical equipment like beds, wheelchairs, and commodes; counseling and support services; and volunteers to “patient sit” for a few hours of respite for the family caregivers. There is more, I’ve just named a few offerings. The point I am making is that Hospice, when called in earlier than days before death, can set the stage for our “death of choice.”

Just like Dorothy says in the Wizard of Oz, “There is no place like home.”

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