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 a critical aspect of healthcare that becomes a pressing issue for elderly clients. Despite the availability of palliative care and hospice programs aimed at providing comfort and support during the end stages of life, a significant number of elderly individuals do not have the opportunity to die in their own homes, despite it being their preference. This paper will explore the reasons behind this trend and discuss the role of nurses in supporting clients regarding end-of-life care in accordance with their wishes. The discussion will be supported by evidence-based literature to provide a comprehensive understanding of the topic.

Reasons for not dying at home

The preference for dying at home is common among elderly individuals. However, there are multiple reasons why this preference is often not fulfilled. One primary reason is the lack of accessibility and availability of appropriate home-based care services. Studies have shown that the provision of end-of-life care at home requires a coordinated effort involving various healthcare professionals and resources (Bajwah et al., 2012). In many regions, the necessary infrastructure and services, such as home nursing care, medical equipment, and medications, may be insufficient or not readily available for elderly individuals to die at home.

Another reason is the reluctance of healthcare professionals, including clinicians and nurses, to provide end-of-life care in a home setting. Some professionals may lack the necessary training or experience in delivering end-of-life care in a home environment, leading to a hesitance to provide this care outside of a hospital or hospice setting. Additionally, concerns about the adequacy of pain management, availability of emergency support, and fear of legal implications may contribute to the preference for care in a facility rather than at home (Newgard et al., 2017). These factors combined can limit the options available for elderly clients and impact their ability to die in their desired location.

Moreover, there may be social and psychological factors that influence the decision to not die at home. Family dynamics, caregiver stress, and financial constraints can play a significant role in determining the end-of-life care setting for elderly individuals. For instance, some families may lack the resources or support system necessary to provide comprehensive care at home, leading to the preference for facility-based care. Furthermore, the emotional toll and caregiving burden associated with providing end-of-life care may be overwhelming for family members, prompting them to choose a facility where they can rely on the expertise and support of healthcare professionals (Fried et al., 2018).

Role of nurses in supporting client wishes

Nurses play a crucial role in supporting clients regarding end-of-life care in accordance with their wishes. As healthcare professionals who often have direct and prolonged contact with clients, nurses are in a unique position to advocate for their clients’ preferences and provide comprehensive care tailored to their needs.

Firstly, nurses can facilitate open and honest conversations about end-of-life care options with their clients and their families. These conversations should occur early in the care trajectory to ensure that clients’ preferences and goals are understood and respected (Houben et al., 2014). By providing information about the available care options, nurses can empower clients and their families to make informed decisions about their end-of-life care.

Secondly, nurses can collaborate with other healthcare professionals and community organizations to enhance the accessibility and availability of home-based end-of-life care services. This can involve advocating for increased funding and resources for home care services, engaging in interdisciplinary care planning, and facilitating seamless transitions between different healthcare settings (Jordan et al., 2019). By actively working towards improving the infrastructure and support for home-based care, nurses can enhance the likelihood of clients being able to die at home if they so desire.

Furthermore, nurses can provide emotional and psychological support to clients and their families throughout the end-of-life care process. This can include regular assessments of the clients’ emotional well-being, providing counseling or therapy referrals as needed, and facilitating family meetings to address any conflicts or concerns (Bonazzi et al., 2021). Nurses can also educate families and clients about self-care and stress management strategies to reduce the impact of caregiver stress and promote overall well-being.


In conclusion, the preference for dying at home is often not fulfilled for elderly clients due to a range of factors, including limited access to appropriate home-based care services, reluctance of healthcare professionals to provide care outside of a facility, and social and psychological considerations. However, nurses can play a crucial role in supporting clients regarding end-of-life care in accordance with their wishes. By facilitating open conversations, advocating for increased accessibility of home-based care, and providing emotional support, nurses can contribute to enhancing the quality of end-of-life care and helping clients achieve their desired outcomes.

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