“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life

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dc.contributor.authorPenning, Margaret J.
dc.contributor.authorCloutier, Denise
dc.contributor.authorNuernberger, Kim
dc.contributor.authorTaylor, Deanne
dc.date.accessioned2017-09-25T20:11:29Z
dc.date.available2017-09-25T20:11:29Z
dc.date.copyright2017en_US
dc.date.issued2017
dc.description.abstractBackground and Objectives: Little is known regarding the care trajectories older adults experience at the end of life (EOL). We drew on a structural/institutional life course perspective to examine the trajectories evident among older adults transitioning through the Canadian formal long-term care system. The sequence of care transitions as well as the impact of social location, social and economic resources, and health-related factors on these trajectories were examined. Research Design and Methods: To identify EOL care trajectories, we used administrative data collected on older adults (aged 65+) who received publicly subsidized long-term care services (e.g., nursing home and home and community-based care) in one health region in British Columbia, Canada from January 1, 2008 through December 31, 2011 and who died by March 31, 2012 (n = 11,816). Multinomial logistic regression analyses assessed the impact of selected covariates on these trajectories. Results: The majority of those studied (65.4%) died outside of acute hospital settings. The most common trajectories involved transitions from home care to nursing home/residential care to non-hospital death (39.5%) and transitions from in-home care to hospital death (22.4%). These and other trajectories were shaped by social structural factors, access to social and economic resources, as well as health status and prior hospitalizations. Discussion and Implications: Despite calls for minimizing hospital-based deaths and maximizing home-based deaths, older LTC recipients often experience EOL care trajectories that end in death in a nursing home care setting. Our findings point to the value of a structural/institutional life course perspective in informing an understanding of who experiences this and other major EOL care trajectories. In doing so, they also provide direction for policy and practice designed to address inequalities and enhance the quality of EOL care.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThis work was supported by grants from the Canadian Institutes for Health Research (CIHR): Partnerships in Health System Improvement (PHSI) Grant Program; the Michael Smith Foundation for Health Research (MSFHR) (to M. Penning, D. Cloutier K. Nuernberger, and D. Taylor, 2012–2016, grant number 122184); and a University of Victoria Internal Research/Creative Project Grant (IRCPG) (to M. Penning, 2016–2017).en_US
dc.identifier.citationPenning, M., Cloutier, D.S., Nuernberger, K. & Taylor, D.(2017). “When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Life. Innovation on Aging, 1(1), 1-13.en_US
dc.identifier.urihttps://doi.org/10.1093/geroni/igx011
dc.identifier.urihttp://hdl.handle.net/1828/8587
dc.language.isoenen_US
dc.publisherInnovation on Agingen_US
dc.rightsAttribution 2.5 Canada*
dc.rights.urihttp://creativecommons.org/licenses/by/2.5/ca/*
dc.subjectEnd of life
dc.subjectHome and community-based care and services
dc.subjectLong-term care
dc.subjectNursing homes
dc.subjectPalliative care
dc.subjectInstitute on Aging and Lifelong Health
dc.subject.departmentDepartment of Geography
dc.subject.departmentDepartment of Sociology
dc.title“When I Said I Wanted to Die at Home I Didn’t Mean a Nursing Home”: Care Trajectories at the End of Lifeen_US
dc.typeArticleen_US

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