Home care services — an alternative to hospices?

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Abstract
Of eight home care services for terminally-ill patients operating in the Trent and Yorkshire Health Regions in 1984 four were attached to in-patient hospices and four provided home care only. Sixty-five per cent of the home care only service patients died at home compared with 29 per cent of patients of hospice-based services, but the hospice-based services cared for more patients per nurse. The introduction of a service was followed by a decline in the proportion of cancer deaths occurring in the patient's home in the districts served by hospice-based services, and an increase in districts served by home care only services. The Spitzer QL score negatively correlated with the input of services (G P, district nurse; home care nurse) as the patient approached death. The provision of a home care service does not constitute a complete alternative to an in-patient hospice, but provides a means whereby more patients may benefit from some hospice-type care.

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