Preventing hospitalization: home hospice nurses, caregivers, and shifting notions of the good death

Abstract

This chapter explores the relationship between hospice home care and the recent trend toward dehospitalization. Hospice home care nurses are increasingly responsible for attending to their employing organization's bottom line, in addition to patient care. Their concern for helping patients achieve the good death thus intersects, and sometimes competes, with their employing organization's interest in controlling patients' access to costly hospital and other acute care. I describe several of the ways in which nurses in this study control home hospice caregivers' abilities to support terminally ill patients' death at home: (1) through their assessments of patient and caregiver appropriateness and competence; (2) by appealing to the caregiver's emotional connection to the patient in order to encourage commitment to the goal of death at home and; (3) by normalizing the idea of death at home. I argue that, through their work of training hospice caregivers to adapt and maintain the value of staying at home, hospice home care nurses provide a subtle, yet significant, new mechanism for dehospitalizing terminally ill patients. Moreover, the work of hospice home care nurses is shifting our understanding of what constitutes a “good death”.

Citation

Leich, J. (2000), "Preventing hospitalization: home hospice nurses, caregivers, and shifting notions of the good death", Jacobs Kronenfeld, J. (Ed.) Health, Illness, and use of Care: The Impact of Social Factors (Research in the Sociology of Health Care, Vol. 18), Emerald Group Publishing Limited, Leeds, pp. 207-228. https://doi.org/10.1016/S0275-4959(00)80029-0