Discharging patients from hospice to nursing home: a retrospective case note review

This article presents a retrospective case note review of in-patients at one UK hospice considered for discharge to nursing homes during 1999 and 2000. The idea of a nursing home placement was introduced, on average, around 9 days after admission to the hospice; the most common reason cited being the inability to cope at home. Nearly a third of the patients expressed negative or ambivalent feelings about the idea. Transferring patients from hospice to nursing home is often necessary to avoid pressures on hospice beds. The potential distress of transferring patients, particularly when nearing the end of life, must be balanced against the needs of patients on hospice waiting lists. Of the 41 cases reviewed, 16 were transferred to nursing homes as planned, with a mean length of stay of just over 8 weeks. The current provision of palliative care in nursing homes raises ethical questions about transferring patients to an unfamiliar environment that may not necessarily be able to offer the same quality of palliative care. Clear communication with patients and their families and a consistent process are important to reduce some of the distress associated with this issue.