A vast majority of hospice services are provided in the home. In fact, according to a recent report published by The National Hospice and Palliative Care Organization (NHPCO), over one-third of hospice services are provided in a private residence. Given the number of patients receiving hospice services in their home, an obvious question arises as to how to prepare a home for hospice.
Dr. R. Sean Morrison, director of the National Palliative Care Research Center at the Mount Sinai School of Medicine in New York, explains: “To even begin to answer that, you have to consider two things – not simply the patient’s situation, but the caregiver’s, too…. What I see that prevents people from being able to stay at home is not their medical needs but the needs of their caregiver — can the caregiver help, are there resources to help, or is that person going to be overwhelmed?”
How to Prepare a Home for Hospice
When preparing a home for hospice, families that are better prepared not only make the process less difficult for themselves, but also can make the process less stressful for their terminally ill loved one. Along these lines, research shows that a lack of preparedness is associated with a greater risk of anxiety, major depression, and complicated grief for both loved ones and caregivers.
Given the importance of being prepared, it is also vital to consult with the hospice care provider and the patient’s care team to create a to-do list to get the home ready. At this time, the hospice provider and members of the care team will likely ask for an overview of the household environment so as to understand what is needed to most effectively provide care to the patient.
One can look at the preparations needed to get the home ready for hospice as falling into two broad categories: caregiver preparation and patient comfort.
Despite the fact that hospice services are being provided in the home, it is important to consider whether the home environment will be conducive for caregivers to assist a patient. Of course, one is not expected to make a home into a hospital room; it should be set up in a way that it is easy for caregivers to do their work while also being a safe environment for the patient to use as well. The following tips are some of the basics a person should consider when preparing a home for hospice.
Make The Home Accessible to Both Patient and Caregiver
One can think of a hospice patient’s home as a workspace and a place for comfort. Accordingly, just as is the case in a hospital or long-term care facility, living areas will need to be safe and accessible for both the patient and caregiver. In this sense, a home should have ample space to move and for the patient to walk around the house safely. In many cases, a patient may need assistance walking. Therefore, the home should be free of hazards in the walkways and, if needed, have grab bars and other mobility assistance devices to prevent falls. Special consideration should be given to the bathroom, which can be a hazard, particularly if a patient has difficulty moving unassisted and performing activities of daily living (ADLs).
In addition to the goal of providing a safe environment for a patient to move and for caregivers to do their work, consideration should also be given to any medical equipment that may be needed while services are being provided. Further consideration should also be given as to whether the patient may need special medical equipment to shower or to move about the house. As stated above, the home environment should be free from obstructions and should be organized in a way that allows equipment, caregivers, and the patient to move freely in the living space.
Find a Suitable Place For a Bed
For patients who will spend a majority of their time in bed, it is important to find an accessible and comfortable area for the bed to be placed. If a patient is having difficulty getting in and out of a regular bed, a hospital bed can provide a safer and easier way for a patient to receive care, and it can also remove barriers to make assisting with dressing and making up the bed a lot easier.
A hospital bed is roughly the size of a twin bed, with a moveable foot and head that can be elevated and lowered. The bed is normally wheeled and contains convertible bed rails for patient safety. When considering where to place a hospital bed, it is important to consider the activity that will be occurring around the bed, ease of access to the bed, and any medical equipment that may need to be near the bed.
Finding a place to put a bed in a home where hospice services will be provided can be difficult given that accessibility, safety, and comfort must be considered. Further, it can be difficult to convince a patient to give up sleeping in their normal bed, and, in some cases, a house’s floor plan may not be conducive to placing a hospital bed where it can be accessed by the patient and caregivers, particularly if it is located up even a few stairs.
According to Dr. Stacie K. Levine, a geriatrician and palliative care physician at the University of Chicago, “A lot of people put the patient in a family room where there is more space, or the dining room if it’s closer to a bathroom, or you might consider a room closer to the kitchen – the center of life and activity for most families.” Ideally, a bed should be placed in an area that is safe and accessible, while allowing the patient to be comfortable.
The guiding principle that underlies hospice care rests in providing patients with comfort during a terminal illness. Therefore, the home environment should be set up so that the patient’s surroundings are as comfortable as possible. One should consider the fact that even though hospice services are being delivered in the home, the home environment should try to be a balance of a caregiving environment and the normal home surroundings a patient is accustomed to. In many ways, this is a balancing act in which the needs of caregivers to provide a safe and workable environment is balanced against the need for a soothing and comfortable environment.
Lighting, Sound, and Temperature
A normal house is often a hub of activity, sounds, and smells. If multiple people live in the house, people will come and go, doors will be opened and shut, the television or radio may be on, appliances will be used. For some patients, the normal activity around a house may be comforting as it may impart a sense of normalcy.
However, certain patients may not be comfortable in a normal household environment. Therefore, it is important to pay attention to what the patient prefers and what will make them most comfortable. One consideration that often arises, particularly for patients who spend extended periods of time in bed, involves making sure windows have adequate shade or covering. Since a bedridden patient will remain in one area for long periods during the day, it is important to make sure sunlight and other artificial light from outside can be blocked if needed so as to avoid excessive exposure to the sun or create restlessness at night.
A healthy person is likely tolerant of some amount of temperature variation in the home. However, individuals who have been taking medications may be sensitive to fluctuations in temperature. Symptoms of the terminal illness may also cause sensitivity to hot or cold. It is important to make sure the patient has access to a fan or heat in the event that normal room temperature does not feel comfortable.
Many aspects of the home environment bring comfort, whether it is a favorite chair, a warm blanket, or the “go to” snack foods one always keeps stocked in the pantry. As patient comfort is a foundation on which hospice care is based, the goal of making patients comfortable can be accomplished by those specific things often considered the comforts of home. Even a patient who must remain in bed for a majority of the time can still benefit from sitting in their comfortable chair, or, if dietary guidelines allow, a patient should have access to all the foods he or she would normally eat while at home. These creature comforts that a patient may access while at home can make a living environment that may seem like a temporary hospital feel more like home.
As the patient’s private residence is used more frequently for hospice services, concerns surrounding how to prepare the home for hospice care can be addressed by consulting the patient’s hospice provider and care team. Once caregiver concerns have been addressed, loved ones can provide a great service to a person receiving hospice care by making the home environment as comfortable as possible. For more information on how to prepare a home for hospice, Contact Harbor Light Hospice.