In this work, the advantages and disadvantages of places for the dying for ill people, precisely a home and a hospital, are considered. Dying is a physically and psychologically stressful process that significantly affects both a terminally ill person and his or her family and loved ones. However, relatives without qualifications and medical facilities cannot provide such care. For this reason, they face severe stress due to the inability to alleviate the suffering of a loved one and the need to be near him or her constantly. Such conditions affect the quality of care due to the high physical and emotional pressure; hence, caregivers preferences are just as crucial as the wishes of a dying person. Consequently, the hospital is a suitable place for dying, since the patients can receive high-quality care, and at the same time decrease the stress of their loved ones, which provide them with greater emotional support.
Death is an integral part of the life cycle; however, often, it is not quick and painless as people die from chronic and dangerous diseases. Medicine offers palliative care to make the last days of a person less painful and more comfortable. For the same reason, many patients prefer dying at home, since they believe their own place will bring them more psychological comfort. At the same time, the preferences of the caregivers about are as critical as the desire of the patients, since the quality of the last days of the dying person’s life depends on their support. However, patients often shift the responsibility for their care to their family and loved ones, causing them physical discomfort and increasing the moral burden. In addition, home care cannot provide a high level of palliative help because the family does not have the means and qualifications. Consequently, the hospital is a more favourable place for dying, since the hospital provides quality care, and therefore, caregivers face less stress and can give better emotional support to a dying person.
The main factors in choosing a patient’s place for dying are his or her health state, the preferences of family caregivers and their presence at home. Gágyor, Himmel, Pierau, and Chenot (2016) argue that the role of the family members weighs much higher in choosing the place of death than the condition of the disease and dying at home increases the quality of the last days of life. However, scientists only take into account the last 48 hours before death, which significantly affects the result of the studies.
At the same time, the preferences of the caregivers depend on many factors, most of which refer to the quality of palliative medicine in the country. Woodman, Baillie and Sivell (2016), in their large-scale study, determined that most caregivers prefer the home as a dying place for their loved ones and relatives. However, a more detailed analysis demonstrates that such a choice is caused by feelings of guilt or duty, a lack of trust in nursing facilities, or a desire to spend more time with the dying person (Woodman, Baillie & Sivell, 2016). The first aspect is related to the fact that the caregivers want to do the greatest possible for their loved ones, and often this aspect is reinforced by the unwillingness of the dying person to be in the hospital. Consequently, many people cannot refuse their loved ones, who previously took care of them, disregarding the resources that they have.
Distrust of medical facilities and the desire to leave a terminally ill patient at home to spend more time with him or her are consequences of a lack of palliative medicine. Witkamp, Droger, Janssens, Zuylen, and van der Heide (2016) note a series of factors that influence the patient’s family choice and satisfaction with the quality of care for him or her. Among them are clear communication, participation in decision making, acknowledgement of their position, trust to health care staff, rest and privacy (Witkamp et al., 2016). The first aspect is related to the fact that relatives would like to know everything about the conditions of their family member to be prepared for changes. It is also easier for the family to experience the fact that the dying patient is not at home if they are involved in decision-making and trust the work of healthcare professionals (Witkamp et al., 2016). In addition, it is essential for the family to know that the patient has everything necessary except treatment, which makes the last days of life more enjoyable. Consequently, if the caregivers do not have access to these options, they trust the hospitals less and wish to care for their relatives at home.
However, the most problematic aspect for most people is the inability to spend enough time alone with their loved one before their death in hospitals or hospices. One of the most common problems for family members is the lack of privacy as well as convenient places to rest (Witkamp et al., 2016). This aspect makes it almost impossible to stay in the hospital and make long visits because families do not have the opportunity to sleep a bit or be alone to grieve. Consequently, caregivers feel both significant discomforts due to their own emotional and physical needs, as well as guilt due to the necessity of leaving the patient alone. For this reason, many people prefer the home as a dying place for their relatives. However, most of these factors that push people away from hospitals can be achieved by a more attentive and sensitive attitude towards patients, which force people to change their mind.
At the same time, there are also many negative aspects of home care that encourage caregivers to choose hospitals or hospices for the last days of their terminally ill relatives. Woodman, Baillie and Sivell (2016) highlight such disadvantages of home dying as limited resources for providing quality care, a high level of the emotional and physical stress of caregivers, and the complication of their the bereavement experience. The last two aspects are interconnected because dying at home imposes a physical, psychological and financial burden on family members, which can make the caregivers feel guilty about their emotions and feelings. For example, the cancer patient’s wife says that she feels guilty but cannot see her husband dying in the kitchen, in which she will have to eat again (Srivastava, 2017). Woodman, Baillie and Sivell (2016) also give an example of how a wife felt guilty for what she could not do for her husband while he was dying at home. Therefore, a hospital or a hospital might be the best choice for both women.
Moreover, the choice of dying at home can also be difficult or impossible if a person does not have the ability to receive proper care. According to Costa et al. (2016) such factors as the presence of a caregiver, lack of loneliness, and visits by healthcare professionals increase the likelihood of home dying; however, not all people have these factors. Even if a nurse often visits the patient, as well as his children or spouse, help him out after their work, he or she does not have constant care. Besides, hiring a private caregiver also incurs financial costs that not every family can afford. Constant care for the dying also often requires taking unpaid weekends, which causes significant stress.
At the same time, hospitals can take some of the responsibility that family members have to bear. People need strength to remain supportive for the dying person and at the same time, relieve stress and grief. For example, a cancer patient lived four years after he decided to die at home, and all this time his wife took care of him, but the inability to provide him full treatment caused him unnecessary pain in the last four days (Kolata, 2019). His wife also notes that she was absolutely exhausted because she needed to care about her husband without any respite (Kolata, 2019). Consequently, home care is often exhausting and painful, while hospital professionals take care of at least the physical condition of a dying patient.
In addition, patients and their families feel more secure in the hospital, since they know that they will receive the help of professionals in critical situations. People often do not have means and experience to care about the condition of their loved ones at home and cause significant physical and moral harm to themselves and to the person they care about. For instance, a woman who cares for an individual with motor-neurone disease expresses gratitude to the hospice for its professional care, since she exhausted by her duties and could perform them well (Woodman, Baillie & Sivell, 2016). The proximity of various medical equipment, medicines and healthcare professionals allow relatives to provide a patient with quality care and save him or her from discomfort and pain. At the same time, the moral support of loved ones can remain as significant and vital as with home care.
In conclusion, multiple factors indicate that the hospital is a more comfortable place for the last days of a patient’s life. Medical care will reduce the discomfort and pain caused by diseases and at the same time, allow the patient’s family members to cope with stress. Most of the caregiver’ preferences for choosing a home as a dying place for their relatives are justified by shortcomings in the palliative medicine system, which cause concern for the emotional state of caring and dying person. At the same time, fixing these shortcomings will help open up the existing benefits of hospital care to people. This topic is especially important because people often do not understand how difficult and painful the last days of beloved person can be for caregivers. Thus, it is necessary to carry out some reforms and make sure that caregivers and patients trust the palliative system for creating the perception in people’s minds about hospitals as their preferred place for dying.
References
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- Gágyor, I., Himmel, W., Pierau, A., & Chenot, J.-F. (2016). Dying at home or in the hospital? An observational study in German general practice. European Journal of General Practice, 22(1), 9–15.
- Kolata, G. (2019). More Americans are dying at home than in hospitals. The New York Times. Web.
- Srivastava, R. (2017). Dying at home might sound preferable. But I’ve seen the reality. The Guardian.
- Witkamp, E., Droger, M., Janssens, R., Zuylen, L. V., & Heide, A. V. D. (2016). How to deal with relatives of patients dying in the hospital? Qualitative Content Analysis of Relatives Experiences. Journal of Pain and Symptom Management, 52(2), 235–242.
- Woodman, C., Baillie, J., & Sivell, S. (2015). The preferences and perspectives of family caregivers towards place of care for their relatives at the end-of-life. A systematic review and thematic synthesis of the qualitative evidence. BMJ Supportive & Palliative Care, 6(4), 418–429.