When facing end-of-life care decisions, many families struggle with choosing between home hospice and facility-based hospice care. Both options have strengths and challenges, and there are many factors that play into determining what the right choice is for you and your family.

This article explores the pros and cons of each option to help you make an informed decision.

Home Hospice Care: Pros and Cons

Home hospice allows patients to receive end-of-life care in the comfort of their own homes. Nurses and other caregivers come to the patient, and the family may choose to hire additional home health aides to assist them with daily living tasks.

This option has several advantages:

1. Familiar Environment

Patients can remain in their own space, surrounded by familiar sights, sounds, and possessions. Most of the time, they can sleep in their own bed, bathe in their own shower, and relax in their own living room. And even if they begin to have limited mobility or need mobility aides, most homes (or at least portions of the home) can be adjusted to be easy for a patient to navigate.

This familiarity can provide comfort and a sense of normalcy during a difficult time.

2. Privacy and Control

Home hospice offers more privacy and control over the care environment. Patients and families can maintain their routines and preferences without adhering to facility schedules. Hospital-like facility environments can rarely create a serene, restful environment.

3. Family Involvement

Loved ones can be more directly involved in care, spending quality time with the patient and participating in caregiving tasks. The patient also generally receives a lot more attention, as care can be spread out among family members.

4. Personalized Care

Care can be more easily tailored to the patient's specific needs and preferences in a home setting, and their caregivers, who are generally family members, already know the patient’s preferences and dislikes, and can accommodate them in the choices related to daily living, like what to feed the patient, or what kind of schedule works best for the patient’s natural rhythms.

5. Cost-Effectiveness

Home hospice is often less expensive than facility-based care, which can be a significant factor for many families.

However, home hospice also presents some challenges:

1. Caregiver Burden

Family members may experience significant physical and emotional stress as primary caregivers, and some may struggle with the myriad of unfamiliar tasks that they now need to complete to assist their loved one.

2. Limited Medical Resources

Immediate access to medical equipment and supplies may be more limited compared to a facility, and so may not be the right choice for patients with certain medical conditions or care needs.

3. Home Modifications

We mentioned this earlier in the “Friendly Environment” section, but not everyone has the resources to sufficiently modify the home to meet the patient’s needs.

4. Potential Isolation

Patients might have less social interaction compared to a facility setting, which could impact their emotional well-being. One way to help with isolation is to make use of the volunteer services offered by many home hospice nonprofits, like Coastal.

5. Patient-Family Relationships

Unfortunately, some families have the burden of strained relationships, either between the patient and one or more family members, or among the family members themselves. Sometimes these differences can be set aside during the patient’s final days, but if they cannot, home-based hospice care may not be the best answer for any of the parties involved.

Facility-Based Hospice Care

Hospice care is available in various settings, including hospitals and dedicated hospice facilities. These facilities offer various levels of privacy, staffing, and equipment.

Some benefits of facility-based care include:

1. 24/7 Professional Care

Trained staff is available around the clock to provide care and manage symptoms, which can be reassuring for both patients and families. It can be very difficult to support a patient who needs constant care, especially if there are only one or two family members available to help.

2. Specialized Equipment

Facilities are equipped with necessary medical equipment and supplies, ensuring immediate access when needed.

3. Respite for Family

Family members can focus on emotional support without the physical demands of caregiving, potentially reducing burnout.

One thing to note that many home hospice patient’s families might not be aware of: many times, respite care services are made temporarily available if you need to travel or even if you just need a few days off to take a break from caregiving.

4. Social Interaction

Patients have opportunities to interact with other residents and staff, which can provide mental stimulation and emotional support.

5. Emergency Readiness

Immediate response to medical emergencies is available, which can be crucial in managing end-of-life symptoms. Remember, however, that hospice isn’t about prolonging the patient’s life via extensive medical interventions, but having emergency access to pain management medications or knowledgeable staff can be nice to have.

However, facility-based care also has some drawbacks:

1. Unfamiliar Setting

The facility environment may feel impersonal or intimidating to some patients, potentially causing distress. As we noted above, many facility environments aren’t particularly restful, and rest is what many hospice patients crave the most.

2. Less Privacy

Patients typically have less privacy than they would at home, which can be challenging for both patients and visiting family members. In some facilities, patients may even share rooms.

3. Visitation Limitations

There may be restrictions on visitation hours or the number of visitors, which can limit family time. Some patients with dementia may not understand why their family members aren’t around sometimes, which can make them feel sad and abandoned.

4. Higher Costs

Facility-based care is often more expensive than home hospice, which can be a significant consideration for many families.

Making the Decision

When deciding between home hospice and facility-based care, consider the following factors:

1. Patient's Wishes: If possible, involve the patient in the decision-making process to honor their preferences.

2. Level of Care Needed: Assess the complexity of care required and whether it can be managed effectively at home.

3. Family Capabilities: Evaluate the family's ability to provide care and handle the emotional aspects of home hospice.

4. Home Environment: Determine whether the home can be adapted to meet the patient's needs safely and comfortably.

5. Financial Considerations: Compare the costs of both options, including any insurance coverage.

6. Support System: Consider the availability of family, friends, and community support for home-based care.

7. Cultural and Religious Preferences: Some cultures and religions may have specific end-of-life care traditions that influence the decision.

It's worth noting that hospice care doesn't have to be an all-or-nothing choice. Some families opt for a hybrid approach, starting with home hospice and transitioning to a facility if care needs become too complex or the family needs respite. You are never stuck with the decision you make right now.

There's no universally "better" option when choosing between home hospice and facility-based care. Each situation is unique, and what works best for one family may not be ideal for another. The most important factor is ensuring that the patient receives compassionate, dignified care that aligns with their wishes and values.

Ultimately, the best choice is the one that provides the highest quality of life for the patient while also considering the well-being of the family caregivers. By carefully weighing the pros and cons and consulting with healthcare providers, families can make an informed decision that best suits their specific circumstances and ensures the most comfortable and supportive end-of-life experience possible.

If you have any questions about home hospice, please reach out to us via our Contact Form, or by giving us a call at 541-469-0405.