End-of-life decisions in the home care setting

Advance directives, which allow a person to record preferences for end-of-life care in case of incapacity, have been underused in home care. In this study, thirty home care clients, who were either elderly or persons with AIDS, were offered the opportunity to execute individualized advance directives and to include issues of specific importance to them. Twenty-three completed and signed their documents; nearly all expressed wishes, fears, and concerns that are both not always adequately addressed and not necessarily capable of "yes" or "no" answers. These are discussed and explained, with guidelines for clinicians.