End of life in intensive care: is transfer home an alternative?

The past decade has witnessed an increased focus on improving the quality of end of life care internationally. This has resulted in the development of specific health policy work streams to support patient choice and improve standards of care and patient experience. One concept well explored in areas outside of critical care is that of home care at the end of life. This paper seeks to challenge assumptions and practices about the options for transferring the critically ill patient home at end of life. As a piece of collaborative writing from a bereaved family member and critical care nursing team, this paper explores care given to one gentleman at the end of his life. In this, his journey is detailed, the decisions made are outlined and the experience for him and his family are examined with a retrospective narrative account from his wife that is woven throughout the paper. In this paper, we are not asserting that transfer home at end of life is desirable or feasible for all critically ill patients. We are challenging practitioners to consider when and how the initiative of transferring critically ill patients home at end of life, may occur.