Questions & Answers: Dying At Home

Medical and Other Considerations Is it necessary to be under a doctor's care while dying at home?

Yes. The doctor's role remains essential. A doctor can act as coordinator of the services a person needs when returning home to die, including finding a hospice program or home healthcare agency. Also, as the dying person's condition and needs change, a doctor is necessary to change treatment orders. Finally, medications, especially those for pain control, normally must be ordered by a doctor.

What is hospice?

The focus of hospice relies on the belief that each of us has the right to die pain-free and with dignity, and that our loved ones will receive the necessary support to allow us to do so.
Hospice care involves a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient's needs and wishes. The goal of hospice is not to prolong life, but to provide medical treatments that alleviate pain or maintain comfort throughout the dying process, and offer other support to dying persons and their families. The medical care provided by hospice often is called "palliative" or "comfort" care. Although some hospitals and nursing homes have units devoted to hospice care, most people receive hospice care in their own homes.

When is hospice a suitable option?

Hospice is an option for people who have been diagnosed with a life-limiting illness and are expected to die within a time, usually six months. Approximately 70-75% of hospice patients have advanced cancer. Increasingly, however, patients with other incurable conditions-such as end-stage Alzheimer's disease, advanced AIDS, and emphysema-receive hospice care.

How does home healthcare differ from hospice?

Home healthcare and hospice provide similar basic nursing in an individual's home. They differ in their goals for providing that care. Hospice treats dying persons only. In contrast, home healthcare is for any patient who needs medical assistance at home. It can include not only palliative care for dying people, but also treatments for those recuperating from surgery or medical illness and ongoing therapies for people with chronic disabilities.
Certified hospice programs are required to offer support to families as well as to dying persons, including counseling, pastoral services, and bereavement support. Home healthcare agencies are not required to provide care to families, although many do.

Can pain or other symptoms be treated adequately at home?

Yes, individuals usually can be made comfortable and pain-free in their homes. Pain or other physical symptoms are not an inevitable part of the dying process, but when symptoms are present, family members often can be taught to administer pain medication and other treatments to keep the dying person comfortable.
At times, however, symptoms can be better managed in a hospital. The person's doctor and hospice team, if appropriate can arrange for admission to the hospital if necessary.

What other assistance may be necessary?

People who choose to die at home may require constant care. Seriously ill or dying patients often need assistance in activities of daily living, such as preparing meals, eating, dressing, bathing, and using the bathroom. Often, these needs may be too much for family members to handle alone and additional help may be needed.
Trained home care workers often can provide this type of essential non-medical "custodial" care when family members need to work, run errands, or simply "take a break" from the responsibility of caring for a dying person.