Home care of the terminally ill.

General issues pertaining to the care of terminally ill patients in their homes are discussed. Lay home-care givers should be recruited as soon as the decision to care for a terminally ill patient at home has been made. Several home-care givers are usually needed for each patient, and the recruitment search should extend beyond the immediate family. Training of home-care givers and patients should be planned so that it fits schedules and covers all details, such as infusion device operation, documentation, and who to contact in case of changes in patient condition. In addition to training, care givers need psychosocial support. In the interdisciplinary approach to home care, pharmacists, nurses, physical and occupational therapists, social workers, and others all participate on a home-care team. Clinical staff members often shoulder much of the responsibility for assessing patient status, informing the physician, and coordinating changes in therapy. The home environment demands flexible policies and procedures and simple, concise methods of monitoring and documentation, especially when intractable pain is being managed. Because less control is possible in the home setting than in the hospital, it may be more difficult to comply with legal requirements concerning controlled substances. Final decisions about how home-care providers will be reimbursed are awaited. Practice standards for home care are being defined and recognized. Home care is a rational alternative for many terminally ill patients but raises new challenges.