New Palliative care tool developed to predict death in home care users: Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT)

A recent Ontario study1 has explored the implementation and validity of new tool to predict death in home care users. Authors and researchers Hsu et al. created the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool, also known as RESPECT. The purpose of this tool is to predict mortality within 6 months for older adults that live within the community but utilize home care services.

Researchers created this tool to predict when older adults, nearing end-of-life will die in order to improve and anticipate their individual care needs. The tool is intended to be used specifically for individuals who are anticipated to pass away within a 5-year period. Questions included in the tool address, sex, age, education level, chronic disease, degree to which home-care services are used, and recent hospitalizations. RESPECT makes predictions based on the commonly administered Resident Assessment Instrument for Home Care (RAI-HC).

Overall, the results of the study suggested RESPECT was effective at providing information about an older individuals survival and anticipating future care needs. Specifically, RESPECT preformed similarly to other predictive models such as Changes in Health, End-Stage Disease and Signs and Symptoms Scale (CHESS). Compared to the CHESS Scale, authors conclude that RESPECT was able to provide more practical survival time projections. An additional benefit of RESPECT is the ability for patients, family-members and caregivers to self-input data, a contrast from other tools which often rely on specific lab results or other intricate medical data.

Predictions became less accurate if used on individuals whose question responses and characteristics lied outside of the normal distribution. The location for this study, Ontario also limits the generalizability of this tool in other geographic locations. In a Global News article2, authors of the research study acknowledged that there are numerous ethical concerns related to sharing a person’s time of death. Namely, informed consent and the potential consequences of patients knowing this information.

Hsu et al. define RESPECT as a risk communication aid and support its implementation in patient care planning. Researchers further suggest that this tool has the potential to contribute to palliative care planning. Currently, this tool is not integrated into the Canadian Healthcare System. However, Hsu et al. note that they intend to explore opportunities to further improve RESPECT’s performance establish its validity.


  1. Hsu, A. T., Manuel, D. G., Spruin, S., Bennett, C., Taljaard, M., Beach, S., … & Tanuseputro, P. (2021). Predicting death in home care users: derivation and validation of the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool (RESPECT). CMAJ193(26), E997-E1005.
  2. Bensadoun, E. & Lao, D. (July 5 2021). New online calculator can predict how long seniors have left to live, what help they need. Global News. Retrieved from: