Social Model Hospice Residential Care Homes: Whom Do They Really Serve?

Abstract

Background Most prefer to die at home, but the Medicare Hospice Benefit does not cover custodial care, making it difficult for terminally ill patients with housing insecurity and/or caregiver instability to access hospice care at home. Objectives To examine the characteristics of patients who received end-of-life care in community-run, residential care homes (RCHs) operating under the social model hospice. Methods A retrospective chart review of 500 residents who were admitted to one of three RCHs in Upstate New York over a 15-year period (2004-2019). Results Patients served by the RCHs included 318 (63.6%) women and 182 (36.4%) men aged 34-101 (M = 77.8). The majority (94.9%) were Caucasian and most had cancer diagnoses (71.6%). Prior to admission, most (93%) patients resided in a private residence, and nearly half (47%) lived alone, but most (81.7%) had full- or part-time caregivers. Nearly all patients were admitted either directly from a hospital (47.5%) or private home (47.2%). Over half (52%) were admitted to RCHs within a month of hospice enrollment, and 20.1% enrolled concurrent with admission. While the average length of stay was 21 days, 50% died within 10 days of admission. Conclusions Community-run RCHs represent a unique approach for improving access to hospice home care for patients with home insecurity and/or caregiver instability, yet most patients had prior caregiver coverage and were admitted from a hospital or home setting, suggesting there is a need for community care settings for patients unable to remain at home in the final weeks or days prior to death.

Experiences of Homeless Recipients of Social Model Hospice Care

“…Gaining access to hospice care necessitated having a home environment (A1), and because TIB residents were not stably housed before admission, their “home” was deemed inadequate until they were adequately housed (A3). Residents' condition of homelessness upon admission differs from other SMHh points of entry, as reported earlier 16 . Housing allowed for symptom management, an important aspect of patient-centered care, and was made possible by the philanthropy of the community (A5).…”

“…Residents' condition of homelessness upon admission differs from other SMHh points of entry, as reported earlier. 16 Housing allowed for symptom management, an important aspect of patient-centered care, and was made possible by the philanthropy of the community (A5).…”

“…A retrospective chart review of 500 residents in 3 New York SMHh facilities showed points of entry to SMH from hospital settings (47.5%), private homes (47.2%), long-term care (4.8%), and homeless shelters (0.5%). 16 A few locations report serving individuals primarily experiencing homelessness, namely, The INN Between (TIB) in Utah, 13 Rocky Mountain Refuge in Colorado, Grace House in Ohio, Solace Friends in Wisconsin, and Welcome Home in Tennessee (personal communication, Britni Smith of Omega Home Network, February 2023), which account for roughly 6% of SMHs. Each SMHh has a unique identity based on its local populations' needs, organizations' missions, and operational constraints such as numbers of residents housed.…”

“…The literature about SMH is growing, 9,11,12,15,16 yet noteworthy is the limited qualitative research from the perspectives of people receiving care. 22,23 The purpose of this study was to elicit the experiences of people receiving SMH care who are considered homeless by the government definition 3 and explore their perceptions of key elements of care.…”

Social Model Hospice: Providing Hospice and Palliative Care for a Homeless Population in Salt Lake City, Utah

“…A unique care delivery paradigm patterned after traditional hospice, called social model hospice (SMH), increases access to hospice care for people without stable housing or social networks 19-25 . The concept was proposed in 2015 19 and further delineated with antecedents, attributes, and consequences in 2021 20 .…”