Palliative Care
What’s the difference between palliative care at home and palliative care at the hospital?

Several factors determine the best place for providing care to a person with a terminal illness. This type of decision requires a balance between patient and family needs, and the availability of resources to meet those needs.

Patient and family considerations include the following:

  • patient and family preference;
  • physical ability to handle aspects of care such as hygiene and movement;
  • medical condition and needs such as administering medications and controlling symptoms;
  • economic, emotional, social and spiritual needs.

Resources available to meet these needs vary among areas and programs, and may include the following:

  • home care services;
  • the health care team;
  • technical resources for symptom control, such as pumps and injections.

When someone wants to be at home, health care providers ask, "Can this person manage at home?” Someone who lives alone, who is physically weak and whose burden of illness limits independence is not safe at home. Alternatives can be a care home, hospice, or hospital. A person’s life expectancy may determine which is best.

Availability of resources is equally important in deciding where to care for someone. A person who wants to stay home needs support from family or friends, and from health care providers. The health care team won’t be in the home around the clock, so family and friends must be willing to participate in care. The health care team must anticipate possible symptoms so it can provide medications and other resources. In some parts of Canada, home care services may include providers trained in palliative care. Cooperation between the health care team and family or friends can prevent possibly distressing symptoms and allow someone to die in comfort at home.

The choice of where to care for someone may come down to providing care in a setting where symptoms can be controlled:

  • A person may need hospital care. In some parts of Canada there may be units intended to have patients stay in hospital for a long period. In other areas palliative care programs are community-based, and have a limited number of palliative care beds. In such programs the patient’s care is managed in the community, but they may be admitted to a designated palliative care unit within a health care facility if necessary. The palliative care team there treats difficult symptoms and works to stabilize the patient. When that is achieved, the patient leaves the unit and goes back home, to a hospice, or to a care home.
     
  • Symptoms can be controlled at home. More planning is needed, but medications and other aspects of care should be the same as in a hospital. Some procedures can only be done in a hospital, and may require a short stay or a visit to a clinic.

One place is no better than another for receiving care. It’s usually the needs and wishes of the patient and family that determine the best place to receive care.