Experiences with home hospice care: determinants of place of death

During the past few years the United States has witnessed the growth of hospice care as an alternative approach for the care of the terminally ill. This paper examines a sample of patients who elected to enroll in a home hospice program. Approximately 57 percent of these patients remained at home until death. The other 43 percent chose to return to a facility where they eventually died. Evidence indicates that patients and caregivers who have more difficulty with terminal care at home are more likely to return to a facility. The analysis explores factors that explain why some patients and caregivers have a more troublesome experience with terminal care at home. Four of the factors tested are found to be related to place of death: (1) the number of visits from hospice nurses, (2) the intensity of contact with the hospice nurses, (3) length of time patients are enrolled in the hospice program, and (4) race of the patient. The implications of these findings are discussed and recommendations for delivery of hospice services are suggested.