Palliative Access Through Care at Home: Experiences with an Urban, Geriatric Home Palliative Care Program
Abstract
The aging of the U.S. population has resulted in a large number of persons with multiple, chronic illnesses and gradual functional decline. Many older adults with these conditions are homebound and have great difficulty accessing medical care. They are also more likely to suffer from unaddressed symptoms and end‐of‐life care needs. Certain groups, such as African‐American patients and patients with dementia, are even less likely to access palliative care and hospice services. Although the informal caregivers attending to such persons may become overwhelmed without adequate support, palliative care, which covers a broad population, is an optimal way to address many of these needs. This article describes a unique, urban, home‐based geriatrics palliative care program (Palliative Access Through Care at Home (PATCH)) designed to address some of these unmet needs. After 1 year of providing service, a mixed‐methods study consisting of chart review, telephone interviews, and face‐to‐face interviews was conducted to assess caregiver expectations of and satisfaction with the program. Caregivers for the elderly, mostly African‐American patients, more than half of whom had dementia, were overall very satisfied with their experience, despite the large amount of time necessary to provide the care that patients required. Themes extracted during qualitative analysis were the desire to remain at home, the need for easy access to a practitioner specializing in geriatrics and palliative medicine, and the challenges of transitions of care. PATCH was able to address many of these needs and provide high levels of caregiver satisfaction.
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Carers' knowledge (e.g., health literacy, the patient's care needs) was linked to their experience of carer burden, and use of urgent care after returning home, and contributed to the ways they engaged with information provided at discharge.
“Carers’ knowledge (e.g., health literacy, the patient’s care needs) was linked to their experience of carer burden, and use of urgent care after returning home, and contributed to the ways they engaged with information provided at discharge [43, 44, 57, 59, 60, 64, 66, 67].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [64]
Older adults with MLTCiD were rarely referred to palliative care services early in their dementia journey due to a lack of awareness of the benefits for patients with dementia (CMOC10).
“For example, while palliative care can support quality of life and prevent unnecessary transitions, older adults with MLTCiD were rarely referred to these services early in their dementia journey due to a lack of awareness of the benefits for patients with dementia (CMOC10) [59, 64, 85, 86].”
From Do hospital-to-home transitions work for older adults with multiple long-term conditions including dementia? A realist review (2025) · cites this paper as [64]
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“Carers’ knowledge (e.g., health literacy, the patient’s care needs) was linked to their experience of carer burden, and use of urgent care after returning home, and contributed to the ways they engaged with information provided at discharge [43, 44, 57, 59, 60, 64, 66, 67].”
- Authors
- Holley, A. P. H., Gorawara‐Bhat, R., Dale, W., Hemmerich, J., & Cox‐Hayley, D.
- Affiliations
- University of Chicago (US)
- ORCID
- Dale, William
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2009-10
- Volume
- 57
- Issue
- 10
- Pages
- 1925-1931
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1484052042
- Cited by
- 45
- References
- 27
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 4 · 2023: 3 · 2022: 6 · 2021: 1 · 2020: 2 · 2019: 3 · 2018: 2 · 2017: 1 · 2016: 4 · 2015: 1 · 2014: 2 · 2013: 4 · 2012: 5
- FWCI
- 2.69
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Keywords
- home-based palliative care, geriatric palliative care, homebound older adults, caregiver satisfaction, informal caregivers, African American patients, dementia, end-of-life care, access to palliative care, care transitions
- MeSH terms
- Aged, 80 and over, Female, Geriatrics, Health Services Accessibility, Home Care Services, Humans, Male, Palliative Care, Urban Population
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