God, so the doctor assured me he will treat me here as
long as he can…so that’s just a bit of dignity.
‘Home alone’ patients are often required to be transferred
to institutional care, which, from a patient perspective,
may be less preferable and, from a service
perspective, is more expensive than home care (Higginson
et al. 1999).
Despite a clear indication of need, reports have
stopped short of suggesting models of care that address
this disadvantage. There is a need for studies that
explore models of care that can extend the period of care
at home for dying people living alone, while supporting
quality of life and maintaining a sense of dignity. Quality
of life is an important aspect of palliative care, with its
emphasis on holistic support for patients (World Health
Organisation, 2010). Various definitions of quality of life
exist, but Farquhar (1995) emphasised social contacts,
social activities and positive emotional experiences.
Chochinov et al. (2002), Chochinov (2006) developed a
comprehensive Model of Dignity that includes a social
dignity inventory. This inventory indicated ways of preserving
patients’ sense of dignity, such as maintaining
privacy boundaries; providing social support; and having
a positive and respectful attitude. According to the
model, distress results from people having to rely on others
or feeling as if they are burdening others before and
after death. Furthermore, we need to develop interventions
that support people living at home that do not have
major resource implications in terms of time and costs
(Higginson et al. 1998).
This study builds on the initial scoping study by testing
two recommended models of care for dying people
who live alone at home. These were: the provision of a
personal alarm and the provision of a care aide. The
study was conducted in collaboration with Silver Chain
Hospice Care Service (SCHCS), a community-based
organisation in Western Australia.
This article reports on the qualitative component of
the study, which explored the type and extent of support
that patients felt they had experienced with each model of care.
The quantitative component is reported elsewhere
(Aoun et al. 2010). The aimof this article is to describe the
experiences of terminally ill ‘home alone’ people using
two models of care and the effect of these models of care
on their physical, social and emotional needs.