Patient's socioeconomic background: Influence on selection of inpatient or domiciliary hospice terminal-care programmes

Data on 234 patients who were admitted to the Melbourne Citymission inpatient and home-care programmes were collected prospectively over a 12-month period from September 1, 1985 and were analysed. The variables that were assessed included age, sex, marital status, country of birth, occupation, address, pension status, diagnosis, previous treatment and subsequent survival. It was found that the patients who were selected into the two programmes differed significantly. Hospice inpatients tended to be single (53% of subjects), older (50% of subjects were more than 70 years of age), uninsured (82% of subjects) pensioners who were very close to death (median survival, 2.6 weeks). By contrast, the patients in the homecare group were comparatively younger (21% of subjects were more than 70 years of age) and were more likely to have partners (37% of subjects were single), not to be pensioners and to have private insurance (48% of subjects); also, their median survival was significantly longer (six weeks). These findings should prove of considerable importance for the planning of terminal-care programmes. In particular, they suggest that the critical issues is not the efficacy of either inpatient or home care but rather the modification of each programme type so that it will serve better the needs of its particular constituency.