Relationship of place of death with care capacity and accessibility: a multilevel population study of system effects on place of death in Norway

Abstract

Background: While the majority of deaths in high-income countries currently occur within institutional settings such as hospitals and nursing homes, there is considerable variation in the pattern of place of death. The place of death is known to impact many relevant considerations about death and dying, such as the quality of the dying process, family involvement in care, health services design and health policy, as well as public versus private costs of end-of-life care. The objective of this study was to analyse how the availability and capacity of publicly financed home-based and institutional care resources are related to place of death in Norway. Methods: This study utilized a dataset covering all deaths in Norway in the years 2003-2011, contrasting three places of death, namely hospital, nursing home and home. The analysis was performed using a multilevel multinomial logistic regression model to estimate the probability of each outcome while considering the hierarchical nature of factors affecting the place of death. The analysis utilized variation in health system variables at the local community and hospital district levels. The analysis was based on data from two public sources: the Norwegian Cause of Death Registry and Statistics Norway. Results: Hospital accessibility, in terms of short travel time and hospital bed capacity, was positively associated with the likelihood of hospital death. Higher capacity of nursing home beds increased the likelihood of nursing home death, and higher capacity of home care increased the likelihood of home death. Contrasting three alternative places of death uncovered a pattern of service interactions, wherein hospital and home care resources together served as an alternative to end-of-life care in nursing homes. Conclusions: Norway has a low proportion of home deaths compared with other countries. The proportion of home deaths varies between local communities. Increasing the availability of home care services is likely to enable more people to die at home, if that is what they prefer.

Quality of End-of-Life Cancer Care in Canada: A 12-Year Retrospective Analysis of Three Provinces’ Administrative Health Care Data Evaluating Changes over Time

“…This indicates that while some gains have been made, opportunities for further improvement remain. In contrast to studies from other countries, Canadian in-hospital death rates remain higher than those in the United States, but are similar to those in Taiwan and Singapore, and lower than those in Norway [ 22 , 23 , 24 ].…”

Psychiatric readmission rates in a multi-level mental health care system – a descriptive population cohort study

“…However, we do not find a consistent gradient between unplanned readmissions and distance to services. This in line with the results of Kalseth and Halvorsen [ 42 ] finding a complex relationship between travel time to hospital and dying in hospital in Norway.…”

Municipal Characteristics of In-Home Death Among Care-Dependent Older Japanese Adults

“…By contrast, high accessibility to hospital beds and LTC facilities has been associated with a lower likelihood of in-home death (as we found in the current study). [15][16][17][18] Although it is possible that some patients substitute one service for another (eg, some patients might be forced to die at home when there is insufficient local hospital bed supply), our interpretation is that there are more patients who miss out on dying at home because of an insufficient supply of physicians and care workers who are able to provide domiciliary end-of-life care. Because Japan has far more hospital beds per capita than other high-income countries, people may spend more of their final days in hospitals.…”

“…At the individual level, in-home deaths have been associated with personal preferences for in-home death; older age; female sex; low functional status; cancer diagnoses or nonacute diseases; and a history of use of in-home services, day services, and short-stay services at the end of life, as well as the presence of informal caregivers. 2 , 5 , 12 , 13 In ecological studies, 2 , 12 , 14 , 15 , 16 , 17 , 18 , 19 in-home death has been associated with higher access to clinics or agencies delivering in-home services provided by physicians, nurses, and care workers, as well as day services provided by care workers. By contrast, numbers of hospitals and nursing home beds per population have been inversely correlated with in-home death.…”