Introduction: The first visit is essential to assess the feasibility of home care because, sometimes, it’s really impossible to care for patients at home. Each time our team analyses contingent situation and then decides home care activation or not, according to presence/absence of some important requirements.
Patients and methods: From 01/01/2001 to 30/09/2003 we made 2974 first visits. In 326 (11%) of them it wasn’t possible to activate home care for the following reasons: in 123 (38%) cases because patient’s family couldn’t guarantee a continuous, 24 hours a day, home assistance; 97 (29.7%) patients had good clinical condition and our service wasn’t necessary. 18 (5.5%) patients had not an advanced cancer. 13 (4%) had a life expectancy much longer than common national and regional indications for palliative care services. In 21 (6.4%) cases other home care services were already working, with full satisfaction of patients and families. 16 (4.9%) patients didn’t give us their consent to our assistance program. In 32 (9.7%) cases there were 2 or more requirements not satisfied. Finally, in 6 (1.8%) first visits other reasons kept us from activating our home care service.
Conclusions: The study points out that lack of continuous home assistance by family is the main reason that makes impossible home care. In some cases the will and the commitment of families, sometimes helped by private assistants, made possible a successive activation of our service. In other situations the proceedings to transfer the patient in our hospice were activated. Anyway, we underline that in a metropolitan context, such as our is, this condition of lack of domestic assistance is a social proble. We also want to emphasize the importance, even in our context, of the informed consent\dissent, that brought to a refusal of our assistance in 16(4.9%) cases, according to patient’s right of choosing e´quipe and place of care.