title: Is there no place like home? Caregivers recall reasons for and experience upon transfer from home hospice to inpatient facilities.
abstract: OBJECTIVE
  To describe caregivers' reasons for transfer from home hospice to inpatient facilities, preferences for site of care and death, and their experiences during these transfers.
  
  
  METHODS
  Retrospective qualitative analysis of interviews with caregivers of deceased hospice patients who had undergone transfer.
  
  
  METHODS
  A university-affiliated community hospice provider.
  
  
  METHODS
  Caregivers of deceased hospice patients who transferred to an acute care hospital, a freestanding inpatient hospice facility, or a nursing home while enrolled in hospice and died between January 2003 and February 2004.
  
  
  METHODS
  A semistructured interview protocol was developed and used for all interviews. Interviews were coded for reasons for transfer, preferences for site of care and death, and experience upon transfer using a grounded theory approach.
  
  
  RESULTS
  Patients transferred because of an acute medical event, an uncontrolled symptom, imminent death, or inability to provide needed care safely at home. Although all caregivers expressed a strong preference for care at home, other concerns such as pain and symptom control, safety, and quality and quantity of life became more important with time. We found significant variation in specific preferences regarding care and site of death. Satisfaction with care at the transfer facilities was determined by clarifying goals of care, following treatment preferences, providing personalized care, and the patient's environment.
  
  
  CONCLUSIONS
  Hospice patients usually transfer to facilities to accomplish goals consistent with good end-of-life care. We can improve their experience by treating patients and their caregivers as unique individuals, exploring and respecting treatment preferences, and creating a pleasant physical environment.
authors.affiliation: Department of Medicine, Duke University, and Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, North Carolina 27705, USA.
authors.forename: Wendy G
authors.initials: WG
authors.lastname: Evans
authors.forename: Toni M
authors.initials: TM
authors.lastname: Cutson
authors.forename: Karen E
authors.initials: KE
authors.lastname: Steinhauser
authors.forename: James A
authors.initials: JA
authors.lastname: Tulsky
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006699:Home Care Services; D017051:Hospice Care; D006738:Hospices; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer