Home care in the last year of life: family member perceptions of unmet need associated with last place of care.

OBJECTIVE

To examine the association of family members' perception about the adequacy of home health services at the last place of care before death.

DESIGN

Retrospective cross-sectional study. Mortality follow-back survey by telephone interview.

SETTING

Home health services.

PARTICIPANTS

Bereaved family members or knowledgeable informants of deceased persons in 22 states.

MEASUREMENTS

Proxy perception of need of home health care during the last 12 months of decedent's life, whether the amount of care received was enough, and last place of care (ie, where the person spent at least 48 hours nearest to the time of death).

RESULTS

Of the 1578 interviews, 622 informants reported that decedents needed home health care in the last year of life. Among decedents needing home health care, 144 informants reported that the home health services provided did not meet their needs. After adjusting for age, gender, insurance, education, race, cause of death, functional status, and place of residence, decedents reported as not receiving enough home health care were 1.8 (95% CI 1.1-2.9) times more likely to die in a nursing home.

CONCLUSION

The perception that home health services before death did not meet the decedent's needs may contribute to greater nursing home use.