The document discusses several reasons why many elderly patients do not die at home as is their preference for end-of-life care. Cultural taboos or not wanting to burden family can influence a patient's choice. Additionally, the physical issues requiring nursing care that occur at the end of life make dying at home difficult. Limited Medicare coverage for in-home care and high costs also present barriers. As nurses, supporting patients' end-of-life wishes involves coordinating spiritual care, clarifying care plans, and acting as a liaison between patients and families. Ensuring comfort and that wishes are followed provides a positive experience.

1. Reply 1
There is not a single specific point in an illness, when end-of-
life care begins. It depends on an individual and progression of
their illness. At stage of terminal illness, despite best care,
attention and treatment. If your loved one comes to the end of
their life, the focus would be to make them comfortable as
possible. Depending on nature of disease, the final stage period
may last weeks, months, or several years. This time palliative
care help to control pain, other symptoms, shortness of breath,
hospice care, support emotionally and spiritually to both
patients and their families.
Dying at home a major challenge; a severe shortage of
professional home care giver, the expense of hiring-quality
help, the difficulties of pulling together a community of family
and friend for 24-hour care, medical advances of recent
decades. Depending on what is available near you, some hospice
offering include in-home care, but Medicare has limited
coverage. Families prefer alternatives that are expensive or
require endless hours. The options come in mind is nursing
homes, 5 thousands-10 thousands/month. Though, at home you
have the smell of cooking, grand children coming, is more
comfortable for elders. Some elders love their life at home but
need more service at home. Dying at home is realistic?
Sandi
Hebley,
an educator at faith presbyterian hospice in Dallas, shares her
visit to japan and New Zealand, observed and found out that the
resources at home are larger more extensive. In Great Britain,
hospice movement started in 1960. Hospice advocate,
Cicely

2. Saunders
placed teams that went to home with case manager several
nurses. That setup made a huge difference there.
To support patient regarding end-of-life. I like the POLST
paradigm, a framework to help and guide a conversation about
what kind of care a patient wants when future health crisis
occurs. Some changes in health care system can improve care of
individual with progressive illness. For example, we should
broaden end-of-life to mean the last years of life, by developing
a health care pathway for chronically ill and declining people
who are at their last years of life as described in “Medicaring”
white paper by Dr. Jonne Lynn. The UK has developed a “Gold
standard Framework” along similar lines. We can learn their
work by studying their approach.
Furthermore nurse can support by
communicating
with members to manage family involvement t, by
focusing on values
by knowing wishes,
help to seek financial and legal advice
such as living will, attorney,
address family conflicts
by involving social worker or hospice specialist,
preparing early
by hospice and palliative care services.
Reference
Bill. W. (2018). How realistic is dying at home. The difference
between where American would prefer to die and where they
do?
Grand Canyon University (2018). Health assessment
: foundation of effective practice.

3. Health assessment of aging adult. Retrieved
from http//
www.gcumedia.com
.
Melissa. W. (2019). Late stage and end-of life care.
Help guide.
Leslie. K. (2013). How we can get to better end-of life care.
Practical information for aging health and
family care giver
Reply 2
End-of-life care becomes an issue at some point for elderly
clients. Even with the emergence of palliative care programs
and hospice programs, most elderly people do not die in their
own home as is their preference. What are the reasons for this
trend?
“
Dying at home is not favored in certain cultures (due to cultural
taboos) and some patients may wish not to die at home, out of
concern that they might be a burden on the family.” (Stanford
School of Medicine, 2020) Being a burden on family or lack of
family is a big concern for many patients. Another reason many
patients are not dying at home is due to the multiple physical
issues requiring nursing care occurring at the time of death.
(Ward, 2018) Limited coverage by Medicare for in home care
during the final days is another barrier. Cost for in home care
can be very expensive and if a lack of finances occurs then it
would be impossible to utilize those services.
Discuss what you can do as a nurse to support your clients

4. regarding end-of-life care in accordance with their wishes.
Support your response with evidence-based literature.
Nursing plays an important role in end-of-life care. Not only do
nurses assist the patients during this difficult time but they also
support the family members. Ensuring patient’s wishes are met
is something the nurse needs to strive to complete during the
end of life timeframe. If the patient wishes to have spiritual
support, the nurse will help coordinate that. (Pathways Home
Health and Hospice, 2020) Create a plan with the patient, if
able, to remove the gray areas on the patient’s wishes. Nurses
will act as the mediator between the family and patient in order
to support the patient’s wishes. (Pathways Home Health and
Hospice, 2020) “Nurses will be comfortable having discussions
about death, and will collaborate with the care teams to ensure
that patients and families have current and accurate information
about the possibility or probability of a patient’s impending
death.” (Rights, 2016) If nurses follow the code of ethics and
patient’s wishes it will provide a positive experience in this
difficult end-of-life care situation.
References
Pathways Home Health and Hospice.
(2020). Retrieved from https://pathwayshealth.org/hospice-
topics/the-critical-role-of-nurses-in-end-of-life-care/
Rights, A. C. (2016).
ANA.
Retrieved from American Nurses Association:
https://www.nursingworld.org/~4af078/globalassets/docs/ana/et
hics/endoflife-positionstatement.pdf
Stanford School of Medicine.
(2020). Retrieved from https://palliative.stanford.edu/home-
hospice-home-care-of-the-dying-patient/where-do-americans-

5. die/
Ward, B. (2018, December 6).
Next Avenue.
Retrieved from https://www.nextavenue.org/how-realistic-is-
dying-at-home/