End-of-life care becomes an issue at some point for elderly clients. Even with the emergence of palliative care programs and hospice programs, the majority of 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 in end-of-life care and in supporting their desires. Support your response with evidence-based literature.

Title: Factors Influencing the Provision of End-of-Life Care for Elderly Clients and Nursing Strategies to Support Their Preferences


End-of-life care is a critical aspect of healthcare, particularly for elderly clients whose desire is to spend their final days in the comfort of their own homes. Despite the availability of palliative care and hospice programs, many elderly individuals do not achieve their preferred place of death. This paper aims to analyze and discuss the various factors that contribute to this trend, along with providing evidence-based nursing strategies to support elderly clients in their end-of-life care preferences.

Factors Influencing the Trend:

1. Lack of Home-Based Care Infrastructure:
One significant reason for the discrepancy between elderly clients’ preference for dying at home and the actual place of death is the limited infrastructure surrounding home-based care. The ability for healthcare professionals to provide adequate and comprehensive care at the client’s residence may be hindered due to a lack of resources, staffing shortages, and limited access to necessary medical equipment and medications (Sanders et al., 2016). Consequently, individuals who desire a home death may be redirected to a care facility where they can receive the necessary 24/7 support.

2. Fragmented Continuity of Care:
Fragmented care, resulting in a lack of continuity, is another factor contributing to the trend of elderly clients not dying in their own homes. This fragmentation arises due to multiple healthcare providers involved in the client’s care, such as primary care physicians, specialists, and different care settings. Transitions between these various providers and care settings can result in miscommunication, conflicting treatment plans, and a lack of coordination, leading to suboptimal end-of-life care (Brajtman et al., 2017). Consequently, the preference for dying at home may be compromised due to concerns about the quality and continuity of care that can be provided in this setting.

3. Insufficient Caregiver Support:
Another factor that affects the feasibility of home-based end-of-life care is the availability and capacity of informal caregivers, typically family members or friends. Elderly individuals who wish to die at home often require extensive physical, emotional, and psychological support, which can be challenging for their caregivers to provide single-handedly (Quinn-Lee, & Riffin, 2017). Caregiver burden, lack of knowledge and skills, and limited access to respite care can place significant strain on informal caregivers, resulting in the need for alternative care settings.

4. Lack of Adequate Palliative Care Services:
While palliative care programs have emerged in recent years, the accessibility and availability of these services may be limited, particularly in non-urban areas. Insufficient palliative care services can result in a reliance on acute care facilities, such as hospitals or nursing homes, for end-of-life care (Pilkington et al., 2019). This disparity between the desired home death and the need for specialized palliative care can contribute to the trend of elderly clients not being able to die in their preferred setting.

Nursing Strategies to Support Clients’ Preferences:

1. Advance Care Planning:
Nurses play a crucial role in initiating and facilitating advance care planning conversations with their elderly clients. These discussions help individuals articulate their end-of-life care preferences, including their desire to die at home. Through open and ongoing communication, nurses can ensure that clients’ wishes are documented, respected, and shared with the rest of the healthcare team (Murray et al., 2017).

2. Education and Training:
To support clients who wish to have end-of-life care at home, nurses can provide comprehensive education and training to both clients and their informal caregivers. This can include teaching caregivers essential skills for symptom management, medication administration, and emotional support. Furthermore, nurses can provide information about available community resources and respite care options to alleviate caregiver burden.

3. Coordinated Care:
Efforts must be made to improve the coordination of care for elderly clients, especially during transitions between care settings. Nurses can act as care coordinators, ensuring effective communication and collaboration between various healthcare providers involved in the client’s care. This coordination can enhance continuity and improve the feasibility of home-based end-of-life care (Brajtman et al., 2017).

4. Collaboration with Palliative Care Services:
Nurses should actively collaborate with palliative care services, advocating for the expansion of these services in both rural and urban areas. By establishing partnerships and influencing policy change, nurses can ensure that elderly clients have easier access to specialized palliative care, therefore increasing the likelihood of remaining at home for end-of-life care (Pilkington et al., 2019).


Several factors contribute to the trend of elderly clients not being able to achieve their preference of dying at home. However, nurses can play a significant role in supporting their clients in end-of-life care and helping them remain in their desired setting. By implementing evidence-based nursing strategies such as advance care planning, education and training, coordinated care, and collaboration with palliative care services, nurses can facilitate a more person-centered and supportive approach to end-of-life care for elderly clients.

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