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In recent years addressing social determinants of health has been increasingly prioritized to improve and reduce longstanding disparities in health care. Over the life course, those experiencing socioeconomic deprivation are disproportionately subjected to higher likelihood of poor overall health status, reduced access to palliative and health services, and poor quality of death.
In palliative and end of life care, home is singled out as the preferred place of care and death. While this may be true for some, this generalization implies that home is the marker for quality care for all. However, it must be acknowledged that not everyone has a home that is safe, comfortable, or appropriate for care, especially in areas of high socioeconomic deprivation.
Wakefield (2022) carried out a retrospective secondary analysis to identify innovative models for equitable long term palliative care. This paper highlights the addition of a 10-bed long term palliative care unit in a purpose-built hospice located among the most deprived neighborhoods in England. The outcome revealed that the long-term palliative care unit was highly accessible for the community and was the preferred place of care for 98% of patients admitted.
When exploring alternative patient appropriate places of care, Wakefield suggests carrying out:
- Qualitative research to better understand patient experiences in the new setting, in addition to prospective formal measures to assess quality and complexity (AKPS, IPOS, ACP).
- Advanced care planning and impact on avoidable acute hospital admissions to support economical evaluation.
This report also emphasized the importance of consideration for cultural and social complexities which can be better understood through sociodemographic data collection. Sociodemographic data provides greater insight on these factors and significantly contributes to the advancement of the sector in providing the highest quality of care for all.
Source: Wakefield D. If not home, where? Implementing an innovative model of care as an alternative place of care & death for patients living in an area of high socio-economic deprivation. Short-report on opening a long-term palliative care unit. Palliat Med. 2022 Nov 6:2692163221133984.
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