How Realistic is Dying at Home?

How Realistic is Dying at Home?

Next Avenue

December 6, 2018

For most Americans, “caring for their loved ones at home is not realistic,” said Rachelle Bernacki, director of quality initiatives at Harvard Medical School Center for Palliative Care. “I do think it’s the best possible outcome—with less chance of delirium, more chance for independence. But we’re behind the eight ball for people to make this happen.” Myriad issues make the scenario of dying at home a major challenge: a severe shortage of professional home caregivers, the expense of hiring high-quality help, the difficulties of pulling together a community of family and friends for 24-hour care and, paradoxically, medical advances of recent decades. “People these days are more ill when they’re dying,” said Dr. Cory Ingram, director of palliative medicine in population health at Mayo Clinic in Rochester, Minn. “The time from being diagnosed to dying is longer. Before, there might have been one [physical] problem; now there are multiple issues that require more nursing care. People have more sophisticated care needs than they did, say, 20 years ago.” Depending on what’s available near you, some hospice offerings (for people near the end of life) include in-home care, but Medicare has limited coverage for hospice. Coverage is only for those who have a hospice doctor and a regular doctor certify that they are expected to live six months or fewer, and the patient must accept palliative care for comfort instead of care to cure any illness. Families can be faced with alternatives that are expensive or require endless hours of “amateur” care. “The options are a nursing home for $5,000 to $10,000 a month, hospice care for around $9,000 a month or in-home care, which is, you guessed it, $9,000 a month,” Ingram said. … Although Bernacki applauds the uptick in community palliative care, she has another pertinent question: “Unless you’re independently wealthy, how can you do that? It seems like we’re getting to the point that dying at home is something only privileged people can do.” (Summary from Hospice News Today, 12/8/18)