PT  - JOURNAL ARTICLE
AU  - Sarah Hoare
AU  - Michael P Kelly
AU  - Stephen Barclay
TI  - Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care
AID  - 10.3399/bjgp19X704561
DP  - 2019 Jun 18
TA  - British Journal of General Practice
PG  - bjgp19X704561
4099  - http://bjgp.org/content/early/2019/06/17/bjgp19X704561.short
4100  - http://bjgp.org/content/early/2019/06/17/bjgp19X704561.full
AB  - Background Enabling death at home remains an important priority in end-of-life care policy. However, hospital continues to be a more prevalent place of death than home in the UK, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment, associated with inadequate family care provision and insufficient professional care delivery.Aim To understand problems in professional and lay care provision that discourage death at home and lead to hospital admissions at the end of life.Design and setting A qualitative study of admission to a large English hospital of patients close to the end of their life.Method Retrospective in-depth semi-structured interviews with healthcare professionals (n = 30) and next-of-kin (n = 3) involved in an admission. Interviews addressed why older patients (>65 years) close to the end of life are admitted to hospital. Interviews were transcribed and analysed thematically.Results Home-based end-of-life care appeared precarious. Hospital admission was considered by healthcare staff when there was insufficient nursing provision, or where family support, which was often extensive but under supported, was challenged. In these circumstances, home was not recognised to be a suitable place of care or death, justifying seeking care provision elsewhere.Conclusion Challenges in home care provision led to hospital admissions. Home end-of-life care depended on substantial input from family and professional carers, both of which were under-resourced. Where either care was insufficient to meet the needs of patients, home was no longer deemed to be desirable by healthcare staff and hospital care was sought.