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Care homes as hospices for the prevalent form of dying: An analysis of long-term care provision towards the end of life in England

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  • Teggi, Diana

Abstract

In the UK and the Westernised countries, most people die aged 80+ from disabling, chronic and degenerative diseases, having spent several years in poor health. There is thus continuity between long-term care (LTC) and end of life care (EOLC) in old age, but this continuity is poorly understood within policy and almost nothing is known about what determines the modality and intensity of LTC provision in old age towards the end of life. Drawing on multinomial logistic regression analysis of the English Longitudinal Study of Ageing (ELSA), this paper evaluates how health and socio-demographic factors affect the relative probability of receiving care through one of five long-term care arrangements (LTCAs) from the time of need at age ≥50 to death; and assesses the consequences this has for the English LTC and EOLC policy and planning. The study reveals that hospices provide end-of-life LTC for cancer diagnoses and adults aged 50–64, while care homes provide open-ended and end-of-life LTC for non-cancer diagnoses, dementia, severe disability, and adults aged 80+. Further, the informal, formal, mixed and care home LTCAs reflect increasing levels of disability and ill-health, and decreasing levels of family support, with differences concerning education and gender. Finally, dementia and Parkinson's disease are the single strongest determinants of high formal LTC provision, and overall high care needs determine high formal LTC provision. Within the English context, the consequences of this are that: 1) Continued reliance on informal family care is not sustainable; 2) To provide free formal LTC to old adults with high care needs is appropriate; and 3) Hospices do not cater for the prevalent form of dying in old age while care homes do, being the de facto hospices for severely disabled, very old (80+) adults with dementia. Yet this is not represented in English EOLC policy and research.

Suggested Citation

  • Teggi, Diana, 2020. "Care homes as hospices for the prevalent form of dying: An analysis of long-term care provision towards the end of life in England," Social Science & Medicine, Elsevier, vol. 260(C).
  • Handle: RePEc:eee:socmed:v:260:y:2020:i:c:s0277953620303695
    DOI: 10.1016/j.socscimed.2020.113150
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    References listed on IDEAS

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    1. Joanna Broad & Merryn Gott & Hongsoo Kim & Michal Boyd & He Chen & Martin Connolly, 2013. "Erratum to: Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available stati," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 327-327, April.
    2. Gott, M. & Small, Neil & Barnes, Sarah & Payne, Sheila & Seamark, David, 2008. "Older people's views of a good death in heart failure: Implications for palliative care provision," Social Science & Medicine, Elsevier, vol. 67(7), pages 1113-1121, October.
    3. Joanna Broad & Merryn Gott & Hongsoo Kim & Michal Boyd & He Chen & Martin Connolly, 2013. "Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 58(2), pages 257-267, April.
    4. Teggi, Diana, 2018. "Unexpected death in ill old age: An analysis of disadvantaged dying in the English old population," Social Science & Medicine, Elsevier, vol. 217(C), pages 112-120.
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    1. Hui Zhang & Wenjing Zhou & Donglan Zhang, 2022. "Direct Medical Costs of Parkinson’s Disease in Southern China: A Cross-Sectional Study Based on Health Insurance Claims Data in Guangzhou City," IJERPH, MDPI, vol. 19(6), pages 1-19, March.
    2. Driessen, Annelieke & Borgstrom, Erica & Cohn, Simon, 2021. "Placing death and dying: Making place at the end of life," Social Science & Medicine, Elsevier, vol. 291(C).
    3. Hollingshaus, Mike & Smith, Ken R. & Meeks, Huong & Ornstein, Katherine & Iacob, Eli & Tay, Djin & Stephens, Caroline & Utz, Rebecca L., 2024. "Mortality risk following end-of-life caregiving: A population-based analysis of hospice users and their families," Social Science & Medicine, Elsevier, vol. 348(C).

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