Facilitating Equitable Subacute-to-Home Transitions for Patients Receiving Palliative and/or End-of-Life Care: A Literature Review

Abstract

Introduction: As people in subacute facilities approach the end of life, the focus of their care often shifts to comfort as they seek to return home. Interventions that aim to improve hospital-to-home transitions do not generally focus on subacute care. Objective: To summarize the existing literature on subacute-to-home transitions for individuals receiving palliative care near the end of life, and to explore whether these interventions are targeted toward marginalized groups to improve their transition experience. Methods: We searched the MEDLINE, Embase, HealthSTAR, and Cochrane Library electronic databases using terms related to end of life, palliative care, and transitions from subacute facilities to home. We identified 896 records and included 29 articles, 11 of which were intervention articles. We searched the 11 intervention articles for equity stratifiers. Results: Of the 29 included articles, four addressed transitions for end-of-life populations, three discussed family caregiver perspectives, and 11 were intervention studies, including regular home visit follow-ups, individualized transition care plans, and an individualized intervention with an advanced practice nurse. Subacute-to-home interventions showed positive outcomes such as reduced risk of hospital readmissions, reduced length of stays, and improved functional status. However, study limitations included small sample sizes, inconsistent definitions of outcomes, and incompletion due to COVID-19. No studies focused on marginalized groups. Conclusion/Discussion: While there was some literature supporting targeted interventions for subacute-to-home transitions for those receiving palliative care or end-of-life care, the included interventions did not target marginalized groups. Further research in these areas is required.