Not Quite Seamless: Transitions between Home and Inpatient Hospice

Background: Although most hospice care occurs in the home, a growing number of patients utilize inpatient hospice settings. An inpatient hospice stay requires one or more transitions in care settings, although little is known about these transitions. Objective/Design: Using ethnographic methods, this study examined the beliefs and practices of older adults, their caregivers, and hospice interdisciplinary team (IDT) members surrounding transitions between home and inpatient hospice. Setting/Subjects: Data collection took place over 11 months in a large not-for-profit hospice agency in the northeast. Data were collected through 18 observations and 38 semistructured interviews with patients, family caregivers, and hospice IDT members. Results: Transitions from home to inpatient hospice centered on three processes: developing a plan for future needs, identifying triggers that signaled increased needs for care, and navigating through phases of increased care. Patients, family caregivers, or IDT members identified triggers for more care, and actions were taken to respond in the home care setting. Challenges to these actions occurred in many phases of care and when needs were ultimately unable to be addressed at home, patients were transferred to inpatient hospice. Conclusions: Understanding how care planning, increased needs, and phases of care influence decisions about transitioning patients to inpatient hospice can guide IDT members in minimizing transitions and providing a more seamless continuum of hospice care.