At Home in the Company of Strangers: The Specialization of Home Care of the Dying 1965-1982

Paper

Friday, July 23, 2004

This presentation is part of : Home Care

Joy Buck, MSN, RN, School of Nursing, School of Nursing, University of Virginia, Charlottesvile, VA, USA

Learning Objective #1: Describe the influence of nursing research and practice on the evolution of community-based care of the dying in Connecticut from 1965-1982
Learning Objective #2: Identify key sociopolitical forces that shaped research agendas, health care policy, and community-based care provision

Purpose: During the 1960s, nursing research documented the stark realities of dying in a medical institution: pain control was virtually nonexistent, and patients often died in a room at the end of the hall, behind a closed door, in pain, and alone. Few studies delved into the almost invisible realms of home care of the dying. This study examines the processes of creating alternatives to hospital-based care of the dying in America. Specifically, it uses Connecticut between 1965 and 1982 as a case study to explore the sociopolitical forces that shaped specialization of home care of the dying.

Method/Sources: A social history framework was used to conduct this study. Primary sources included oral histories and archived papers of early hospice leaders and community nurses, Visiting Nurses Association and private foundation records, and legislative histories.

Findings: The deinstitutionalization and expansion of third party reimbursement for home care significantly shaped care provision. In the 1970s, health reformers turned to hospice as a humane and cost effective alternative to institutionalized dying. Hospice was in stark contrast to institutional terminal care; it differed little from traditional home care. As care of the dying transitioned from institution to home, tensions arose between individuals and organizations providing this care. Cooperation between hospice and non-hospice agencies turned into competition--the ideals of care co-opted in the struggle for organizational viability.

Conclusions: Hospice cut across many boundaries and challenged assumptions about the locus of care provision and control of care decisions for the terminally ill. Molding the hospice ideal into a reimbursable model of care ultimately served to further professionalize and specialize home care of the dying.

Implications: This study raises critical questions about the rationality and US health policy and of how research, practice, and theory do or do not inform it.

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Back to 15th International Nursing Research Congress
Sigma Theta Tau International
July 22-24, 2004