Hospice and home care for persons with AIDS/ARC: meeting the challenges and ensuring quality

Every community is or will be faced with the challenge of caring for individuals with acquired immunodeficiency syndrome (AIDS) and AIDS-related complex (ARC). In most communities in the United States, home health care is an existing alternative to hospitalization. Although there are many potential barriers to home health and hospice care provision, these barriers are not insurmountable. As demonstrated by the community's response in San Francisco, careful planning, cooperation, and education reduce the barriers to allow persons with AIDS/ARC to receive care at home or to identify alternatives when home care is no longer an option. The AIDS Home Care and Hospice Program of the Visiting Nurses and Hospice of San Francisco is used as the model for the article. This program was the first of its kind in the world. It has developed an innovative approach to home and hospice care for persons with AIDS/ARC. Its sensitive and humane approach, offers support from early in the disease process (to assist patients as they struggle with difficult treatment decisions) until long after death occurs (to enable friends and family members to cope with the loss of a loved one). This article identifies the challenges that administrators and staff face in keeping the terminally ill individual with AIDS/ARC at home, offers suggestions to best meet the needs of the person with AIDS/ARC living at home, and suggests alternatives when home care is no longer an option.