End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, most elderly people do not die in their own home as is their preference. What are the reasons for this trend? Discuss what you can do as a nurse to support your clients regarding end-of-life care in accordance with their wishes. Support your response with evidence-based literature.


End-of-life care is an essential aspect of healthcare that becomes a significant concern for elderly clients. Despite the availability of palliative care programs and hospice services, the majority of elderly individuals do not have the opportunity to die in their own homes, contrary to their preference. This trend is influenced by various reasons, including systemic factors, cultural beliefs, and personal choices. As a nurse, it is crucial to provide appropriate support to clients regarding their end-of-life care, ensuring that their wishes are respected and their needs are met. This paper will discuss the reasons for the trend of elderly clients not dying in their own homes and explore the role of nurses in supporting clients’ end-of-life care preferences based on evidence-based literature.

Reasons for the Trend

1. Systemic Factors

One reason for the trend of elderly clients not dying in their own homes is the influence of systemic factors. The healthcare system often prioritizes institutionalized care settings, such as hospitals and nursing homes, over home-based care. This preference for institutional care is primarily driven by the availability of medical technology and specialized healthcare professionals, which are more readily accessible in healthcare facilities (byrne). The focus on curative treatments and the perception that hospitals and nursing homes provide better quality care can deter elderly individuals from pursuing end-of-life care in their own homes.

Additionally, reimbursement policies and the financial burden associated with home-based care can pose significant challenges for elderly clients and their families. Medicare and other insurance policies may provide more coverage for care received in healthcare facilities, making it cost-prohibitive for individuals to opt for home-based end-of-life care (umulong). The lack of adequate financial support creates barriers and limits the options available to elderly clients who wish to die in their own homes.

2. Cultural Beliefs and Traditions

Cultural beliefs and traditions surrounding death and dying can also impact the trend of elderly clients not dying in their own homes. In some cultures, dying at home is considered a sacred and natural process, where family members actively participate in providing care and support to the dying individual (fisk). However, in other cultures, institutionalized care settings may be preferred for a variety of reasons. For instance, religious beliefs and rituals may dictate that dying individuals receive specific religious practices or be in the presence of religious figures, which are more easily facilitated in healthcare facilities (goodman). Moreover, cultural norms or limited resources may make it challenging for families to provide adequate care for dying individuals at home, leading them to choose institutionalized care for end-of-life needs.

3. Personal Choices and Circumstances

Personal choices and circumstances also play a role in elderly clients not dying in their own homes. Some individuals may have limited social support networks or living arrangements that make home-based care challenging or impractical (harsch .additionally, individuals with complex medical conditions or symptoms may require advanced medical interventions that are more easily accessible in healthcare facilities (cherny). Fear or anxiety related to dying at home and the potential burden it may place on family members can also influence the decision to pursue institutionalized care.

Role of Nurses in Supporting Clients’ Preferences

Nurses play a crucial role in supporting clients’ preferences regarding their end-of-life care. By incorporating evidence-based practice, nurses can both advocate for and educate clients and families about the available options for end-of-life care, including the possibility of dying at home. Nurses can help bridge the gap between institutionalized care settings and home care by facilitating discussions and collaborations between clients, their families, and healthcare providers (taylor). Additionally, nurses can provide comprehensive assessments and ongoing monitoring to ensure that clients receive personalized care that aligns with their wishes and goals (stajduhar). By practicing culturally sensitive care, nurses can respect the diverse beliefs and traditions surrounding death and dying, and support clients in making informed decisions (mannix).


The trend of elderly clients not dying in their own homes is influenced by various factors, including systemic factors, cultural beliefs and traditions, and personal choices and circumstances. Addressing this trend requires a multifaceted approach that encompasses changes at the systemic level, cultural awareness and sensitivity, and person-centered care. Nurses have a critical role in advocating for and supporting clients’ end-of-life care preferences. By integrating evidence-based practice and providing comprehensive assessments, education, and emotional support, nurses can empower clients to make informed decisions and ensure that their end-of-life wishes are honored. Through collaboration with clients, families, and healthcare professionals, nurses can work towards improving end-of-life care outcomes and enhancing the quality of life for elderly clients.

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