I have two hospice patients right now. Both men, both in their 90s, both WWII vets, both with attentive and loving families. But one man has various heart and diabetes issues and lives in a full nursing home. The other is in end-stage dementia at home.
And there is all the difference.
The longer I work in hospice, the less I like nursing facilities. I can't assign blame, though there is enough evidence that it is warranted. Not that it would help to blame. But the staff is overworked, the patients are lonely and bored and often overmedicated, the facilities are so crowded and so noisy, and the families very frequently absent. It's like factory farming our old people. And we've all seen those awful videos of miserable, suffering cows, chickens, and pigs.
And at home, my patient is in his own quiet room, with a daily attendant to handle physical needs in the morning, and his family there in the home (today, baking Christmas cookies) with the support of his hospice team.
Now, I don't know the difference in price exactly, but I do know that the man at home has a stay-at-home daughter-in-law and the man in the facility has working children and grandchildren. I've heard that the home-option is not wildly more expensive, if you have the people and the space. Which is a challenge for so many.
My patient at home is actively dying--I probably won't see him again, though I'm going back in just a few days. But it is peaceful. I sang Christmas carols to him while the lights glowed on the little tree on his dresser. His own tree, mind you, which he'd had for years.
My nursing home patient is still really active and fairly mobile for a hospice patient; we have great conversations . . . as long as I am careful not to make him late for lunch! He starts looking at his watch 45+ minutes early. I will see him again soon, too. And I'll know that, especially in his case, my presence makes all the difference because of where he is.
I don't think I need tell you which one I'd prefer to have at the end . . . .