Home: Concept and Care Preferences
Below is an overview of research and scientific studies that support the theory that people prefer to heal and be cared for at home and that the concept of "home" is fluid.
People prefer to heal and be cared for at home
- A study about helping people achieve their preferred location of care identifies the location as an important indicator of quality end-of-life (EOL) care. The home was the most preferred location for many patient and about half of the asked people preferred to be cared for at home (47%).
- The proportion of people who prefer to be cared for at home versus in a hospice at the end of their life varies between studies. The range for people who prefer to be cared for at home varies between 25% and 87% and the range for people who prefer to be cared for in a hospice ranges between 9% and 30%.
- Most people prefer to be cared for and die at home, but this does not always happen.
- Even though most people die in hospitals in most countries, few want to be cared for in this facility. Informal carers also highly value home care (25%–64%).
- More than 50% of Australians die in hospitals, yet only one-fifth of patients would prefer to be cared for in a hospital.
- In general, 47% of patients (n-93) prefer home care either in their own home or in a relative's home.
REASONS FOR HOME CARE
- It is usually cheaper to provide care at home than in a healthcare setting, even for technology support cares.
- Home is the care recipient’s territory and can be considered as a place where they are accustomed to making the decisions and running the show. It allows them a greater sense of autonomy and for the care provider to focus on the care recipient’s goals and wishes or centered care. Also, it is easier to maintain social, community, and family ties from home.
- At home, care recipients may feel more comfortable, be able to better control pain and anxiety, and be "less likely to experience serious complications such as infections or confusions." Care workers can also better determine what factors at home contribute to the recipient's sustained health and recovery, such as nutrition.
- People receiving care in their homes may not consider themselves as "patients" and care in the home is a balance between respecting the care recipient’s autonomy, prioritizing their goals of care, and mitigating risks presented by the environment.
- The elderly can best receive health care at home because the care is less expensive in that environment and it was proved to be crucial for obtaining optimal health outcomes.
- The home environment allows the primary carer to sustain caring.
- Factors that are crucial to well-being are maintaining one's sense of identity, feeling a sense of belonging, and connections. At home, the well-being of the carer can be nurtured the best.
- The important role home plays as a place of well-being and support for informal caring networks when providing end-of-life care is hardly recognized.
HOME CARE VS HOSPICE CARE
- Patients who prefer hospice care are usually 55 years and older, female, single, and have a high socioeconomic status, patients who prefer home care are usually younger, male, have better physical health but poorer mental health.
- The perceived benefits of home care were that family and friends could provide care to the recipient, that the care recipient is in surroundings that are familiar, that the recipient is physically close to those they love, that the recipient is not alone, and that the recipient's family can experience a more “normal life.”
- The care recipients' greatest worries for home care are that their pain might not be managed well, that they might emotionally scar their family or friends, that they do not have access to expert medical care, that their friends and family might not know what to do while they are dying and after death, and that they might not be found for some hours after they have died.
- The perceived benefits of hospice care were that the care recipient's pain would be managed well, that the care recipient would not form a burden for their family and friends, that their family would have a more "normal life", that the recipient would have access to specialized medical care, and that medical personnel would always be available.
- The care recipient's greatest worries with regard to hospice care were that they would be in unfriendly and clinical surroundings, that their friends' and families' last memory of them would be in a hospice facility, that there is no privacy, that they were not ready to die, and that they would be isolated.
The concept of "home" is fluid
- How the home is experienced is fragile and continually changes with age, health, and life events. "Home can be a memory enhancing device helping family caregivers to hold to their memories."
- Even though people prefer to age and be cared for at home, its role and meaning for caregivers has been insufficiently studied.
- An academic study on the meaning of home found that "home is everything" and identified two major themes. The first theme was that home can have different meanings and can be regarded as a safe haven or can look like a hospital and feel like a prison. The second theme is how the impact of a home is perceived, should one relocate or stay at home but redefine the home environment.
- Home is very important to "a caring networks formation and function in end-of-life care."
- Home can be seen as a place where people feel comfortable and that they belong, where they have social connection and where collaborative care is given, where they are connected to nature and non-humans, where they have achievements and triumphs.