Death at home following a targeted advance-care planning process at home: the kitchen table discussion

J Am Geriatr Soc. 2001 Jun;49(6):778-81. doi: 10.1046/j.1532-5415.2001.49155.x.


Objective: To determine whether home health agency patients' preferences to die at home can be honored following a structured, professionally facilitated advance-care planning (ACP) process provided in the home.

Design: A case series of patients who were identified by their home health agency nurses as having a life-limiting illness and then referred for social service assessment, followed for at least 6 months, with median follow-up of 191 days.

Setting: A large, urban, home health agency owned by a not-for-profit integrated healthcare system.

Participants: Eighty-four adult patients (median age 75, range 37-94) receiving home care services other than hospice.

Intervention: Formally structured social work visits at patients' homes to discuss end-of-life issues, with communication of results to home health nurses and attending physicians. Social workers performed standard psychosocial assessments, obtained patient and family preferences regarding end-of-life care, and provided education about hospice services.

Measurements: Acceptance of the ACP process, preferences for location of end-of-life care, location of care at the end of life, adequacy of timing of intervention as measured by length of life after ACP, and use of hospice services.

Results: Eighty-three of 84 participants (99%) were willing to complete an ACP process in the home setting. Of the 54 patients expressing a clear preference for location of end-of-life care, 46 (82%) wanted this care to be at home. Thirty-nine (46%) of the participants died within 90 days of ACP; 58 (69%) died by the end of the study. Forty-three (75%) of these deaths occurred at home or in a hospice residence. Fifty-one (61%) patients used home, residential, or nursing home-based hospice services during the study.

Conclusion: In this series of seriously ill home health patients, most preferred to die at home and virtually all were willing to participate in a home-based ACP process. Facilitating ACP among such patients and their families was associated with end-of-life care at home. Use of hospice services was common following ACP in this population.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Advance Care Planning*
  • Advance Directives*
  • Aged
  • Aged, 80 and over
  • Family / psychology
  • Female
  • Follow-Up Studies
  • Health Services Research
  • Home Care Services / organization & administration*
  • Humans
  • Male
  • Middle Aged
  • Minnesota
  • Needs Assessment / organization & administration
  • Outcome and Process Assessment, Health Care
  • Patient Care Planning / organization & administration*
  • Patient Education as Topic / organization & administration*
  • Patient Participation*
  • Program Evaluation
  • Referral and Consultation / organization & administration
  • Social Work / organization & administration*
  • Terminal Care / organization & administration*
  • Total Quality Management / organization & administration