Title: Factors Influencing End-of-Life Care Location and Nursing Support for Preference in the Elderly
Despite the availability of palliative care and hospice programs, the majority of elderly individuals do not die in their own homes, contrary to their expressed wishes. This trend raises questions surrounding the reasons behind it, as well as the role nurses can play in supporting clients’ end-of-life care preferences. This paper intends to explore the factors influencing end-of-life care location and discuss nursing interventions to align care with clients’ wishes.
Factors Influencing End-of-Life Care Location:
1. Medicalization of death:
The medicalization of death, where it becomes increasingly institutionalized, has played a significant role in diverting individuals from dying at home. The dominance of hospitals, nursing homes, and other healthcare facilities, along with the advancement of medical technologies, has shifted the place of death away from homes towards medical institutions (Kwak et al., 2017). The perception that hospitals provide better symptom management and access to specialized care may contribute to this trend.
2. Availability of family support:
Another critical factor is the availability of family members who can provide the necessary support and care at home. Elderly individuals without family caregivers or those with limited familial support often find it challenging to remain at home during end-of-life care. Financial constraints or geographic disparities can further exacerbate the lack of available family support (Gao et al., 2018). Consequently, individuals may require institutional care due to limited options.
3. Complex care needs:
The complex care needs associated with the end-of-life phase can also influence the decision to opt for institutional care. Effective pain and symptom management, as well as intensive care requirements, may necessitate more advanced medical interventions, which are commonly available in hospitals or palliative care units. Fear of being unable to receive adequate care at home, due to the complexity of their condition, could deter elderly individuals from pursuing home-based end-of-life care (Zimmermann et al., 2014).
Nursing Support for End-of-Life Care Preference:
1. Advanced care planning:
One crucial nursing intervention involves facilitating advanced care planning discussions with elderly individuals and their families. Advanced care planning enables clients to articulate their preferences regarding their place of death, including the desire to die at home. These discussions should focus on aligning the client’s values and goals of care with the available resources and options (Houben et al., 2014). By engaging in these conversations, nurses can support clients in making informed decisions and ensure their preferences are documented and respected.
2. Education and skills training:
Nurses can provide education and skills training to family caregivers to increase their confidence and ability to care for their loved ones at home. This may include instruction on symptom management, administering medications, and basic nursing tasks. By equipping family caregivers with the necessary knowledge and skills, nurses empower them to fulfill their loved one’s wish of receiving end-of-life care at home (Norton et al., 2015).
3. Collaboration and coordination:
Collaboration with the interdisciplinary team, including physicians, social workers, and palliative care specialists, is vital in supporting clients’ preferences for end-of-life care. Nurses can serve as advocates for their clients, ensuring that their wishes are effectively communicated and integrated into their care plans. Additionally, coordination of services such as home healthcare, palliative care, or hospice programs can be facilitated by nurses to meet the comprehensive needs of clients and their families (Pattison et al., 2017).
Various factors contribute to the trend of elderly individuals not dying at home, despite their preference for home-based end-of-life care. Understanding these factors helps nurses identify potential barriers and develop strategies to support clients in achieving their desired care location. Through engaging in advanced care planning discussions, providing education and skills training to family caregivers, and promoting collaboration and coordination within the interdisciplinary team, nurses can play a crucial role in supporting clients’ end-of-life care preferences.