Abstract
OBJECTIVES: Older adults in need of residential services are increasingly spending their final days in small, domestic-style care settings such as adult family homes. In this study, we sought to identify processes that facilitated the provision of quality hospice care to seriously ill residents of adult family homes and their family members. DESIGN: We conducted a secondary analysis of qualitative data collected as part of a randomized clinical trial of a problem-solving intervention for family members of hospice patients. SETTING: The original trial was conducted in partnership with 2 large, community-based hospice agencies in the state of Washington. PARTICIPANTS: Data from 73 family members of residents of adult family homes receiving hospice services were included in the analysis. MEASUREMENTS: Data were collected via semi-structured individual interviews, which were audio-recorded and transcribed prior to analysis. RESULTS: Family members described quality hospice care in the adult family home as care that is consistent with residents and families' values and that results in comfort and social connectedness for residents while promoting peace of mind and decreasing burden for residents' families. They identified numerous processes that facilitated the provision of quality care including personalizing care, sharing information and expertise, working together to resolve conflicts, and prioritizing residents and families' values over existing or competing philosophies of care. CONCLUSION: The adult family home setting can amplify both the benefits and challenges associated with receipt of hospice. When choosing an adult family home, older adults and their families should strongly consider selecting a home with a track record of positive collaborations with hospice agencies if the need for end-of-life care is anticipated.