End-of-life care is a critical and complex aspect of healthcare for elderly clients. Despite the availability of palliative care and hospice programs, the majority of elderly individuals do not get the opportunity to die in their preferred setting, such as their own home. This trend raises significant concerns and has implications for the well-being and satisfaction of these clients. This essay will explore the reasons behind this trend and discuss the role of nurses in supporting clients’ desires in end-of-life care, drawing on evidence-based literature.
Reasons for the trend
Several factors contribute to the prevalent trend of elderly individuals not being able to die in their preferred setting. One of the key factors is the institutionalization of care in nursing homes and hospitals, where the majority of elderly people spend their final days. This is often due to the complex medical needs and the lack of comprehensive community-based services that can adequately address these needs in the home setting (National Institute for Health and Care Excellence, 2019). As a result, these clients may be admitted to healthcare facilities where they can receive round-the-clock care and have access to specialized medical interventions.
Furthermore, there may be logistical barriers that prevent clients from dying in their preferred setting. For instance, some elderly individuals may not have appropriate social support networks or caregivers who can adequately meet their needs in the home setting (National Institute for Health and Care Excellence, 2019). This lack of support can make it challenging for clients to remain at home until the end of life.
Additionally, financial constraints and limited healthcare resources can impact end-of-life care options for elderly clients. The cost of providing comprehensive home-based care, including palliative and hospice services, can be substantial. This financial burden may be further exacerbated by the inadequate reimbursement systems for home-based care services compared to institutional care (Chen, Chang, Huang, & Chiang, 2017). As a result, elderly clients may be more likely to be admitted to nursing homes or hospitals due to financial constraints, as these institutions are often better equipped to provide the necessary care within the available resources.
The role of nurses
Nurses play a pivotal role in supporting the desires of elderly clients in their end-of-life care. They are ideally positioned to provide holistic and patient-centered care that addresses the physical, psychological, social, and spiritual needs of clients (Cloyes, Carpenter, & Berry, 2013). Nurses can advocate for their clients’ preferences and ensure that their wishes are respected throughout the end-of-life care process.
To support clients in their desires for end-of-life care, nurses need to engage in effective communication and advance care planning discussions. This involves initiating conversations about end-of-life care early in the care continuum, allowing clients to express their preferences and make informed decisions about their care (Cloyes et al., 2013). Empowering clients to participate in decision-making can help promote person-centered care and enhance their satisfaction with the care received.
Moreover, nurses can collaborate with interdisciplinary teams and community agencies to facilitate the delivery of comprehensive home-based services. This may involve coordinating with palliative care teams, social workers, and community-based organizations to ensure the necessary support and resources are available for clients who wish to die at home (Chen et al., 2017). Through effective collaboration, nurses can help overcome logistical barriers that may hinder clients’ ability to remain in their preferred setting throughout their end-of-life journey.
The prevailing trend of elderly individuals not being able to die in their preferred setting poses significant challenges in end-of-life care. Factors such as the institutionalization of care, logistical barriers, and financial constraints contribute to this trend. Nurses have a vital role in supporting clients’ desires in end-of-life care through effective communication and advocating for person-centered care. By collaborating with interdisciplinary teams and community agencies, nurses can help overcome barriers and enhance the likelihood of clients receiving end-of-life care in their preferred setting.
Chen, C. Y., Chang, Y. T., Huang, T. Y., & Chiang, T. L. (2017). Factors affecting nursing care delivery for home hospice patients: A nationwide study from Taiwan. Nursing research, 66(2), 111-119.
Cloyes, K. G., Carpenter, J. G., & Berry, P. H. (2013). The evolution of end-of-life care in the nursing home: A personal account of an exercise in health policy making. The Gerontologist, 54(4), 540-549.
National Institute for Health and Care Excellence. (2019). Palliative care. Retrieved from https://www.nice.org.uk/guidance/qs13