PLACE OF DEATH AND ACCESS TO HOME CARE SERVICES - ARE CERTAIN PATIENTGROUPS AT A DISADVANTAGE

Research indicates that fewer people are able to die at home than woul d wish to do so. Furthermore the ability to die at home is unequally d istributed depending on patient characteristics. Unless factors associ ated with home deaths are identified and interventions are targeted ac cordingly, further general improvements in care support may only help those already at an advantage. This paper reviews research investigati ng the relation between patient characteristics and home deaths and co nsiders whether these variables influence place of death because they are associated with differential access to services, focusing on acces s to palliative home care. Patients with informal carer support were b oth more likely to die at home and to access palliative home care. Pro vision of home care did not remove the dependence on informal carers i n achieving home death, however.,An important target in improving home death rates is therefore better support for informal carers overall. Older patients were both less likely to die at home and to access home care. Once in home care they no longer were less likely to die at hom e. Although age related needs require consideration, improved access t o home care is therefore likely to increase home deaths for older peop le. Women were less likely to die at home than men, yet younger women may be more likely to access home care. There is same evidence to sugg est that men were less efficient as carers, which may help explain why women were less likely to achieve home deaths, while making their ref erral to home care more likely. While home care may help redress the g ender imbalance, men may also need to be encouraged and enabled to tak e on the carer role. Cancer patients in higher socioeconomic groups we re both more likely to die at home and to access home care. Hence home deaths may increase by improving access for lower socioeconomic group s to the services available. (C) 1998 Elsevier Science Ltd. All rights reserved.