Transitions Between Care Settings at the End of Life Among Older Homecare Recipients

Abstract

Objectives: Objectives were to (a) describe transitions between care settings in older homecare recipients at the end of life, and (b) examine what personal (e.g., age, sex) and health system factors (e.g., hospital bed supply) predict care transitions. Methods: The study involved analysis of administrative health care data and was based on a complete cohort of homecare recipients aged 65 years or older who died in Manitoba, Canada between 2003 and 2006 (N = 7,866). Results: More than half of homecare recipients had at least one care transition in the last 30 days before death and 21% had two or more hospitalizations in the last 90 days. Both personal characteristics and health system factors were related to transitions and hospitalizations. Discussion: The findings suggest that homecare recipients are an important population to focus on in terms of reducing potentially burdensome transitions and enhancing the end-of-life experience for them and their family.

Comparing unplanned and potentially planned home deaths: a population-based cross-sectional study

“…Transitions in the last phase of life is another important factor to consider when evaluating quality of end-of-life care. Transitions in the last months and days before death are common, with more than half of dying people having at least one transition [ 33 , 34 ]. Transitions are shown to be more common in home-dwelling people, where about half have a final transition from home to hospital [ 33 , 34 ].…”

“…Transitions in the last months and days before death are common, with more than half of dying people having at least one transition [ 33 , 34 ]. Transitions are shown to be more common in home-dwelling people, where about half have a final transition from home to hospital [ 33 , 34 ]. Groff et al found an inverse relationship between number of days in domiciliary care and days spent at home in the last six months before death, interpreted as doing more of one thing led to doing more in other areas as well, and did not necessarily improve patient-centred goals [ 35 ].…”

A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions

“…Aaltonen et al’s studies published in 2012 and 2013 used data collected prior to 2002–03 [13, 14]. Moreover, a 2016 publication used 2003–06 data [15].…”

Experiences of older people dying in nursing homes: a narrative systematic review of qualitative studies

“…This is a very important aspect of many people’s experiences and is often regarded as undesirable. 39 These transitions deserve recognition and exploration but have a different focus and were not included here.…”