Foster care: What place for patients in palliative care?

Purpose. To confirm the hypothesis according to which foster care can be an alternative to hospitalization for young patients, receiving palliative care, in a situation of social impasse. Methods. - Qualitative, transversal and bicentric study (Poitiers and Angers, France). Focus group consulting with the hospital social workers, aimed at verifying the project relevance. A second investigation with foster families, using individual interviews, permitted to confirm the feasibility of the project. Data analysis used the Nvivo10 software. Results. - Two focus groups were formed with six social workers. Situations of social impasse were a reality. Hospital discharge was essentially compromised by isolation. The available alternatives were either inappropriate (hospice, long stay unit) or inaccessible because of availability issues (social and healthcare structures for the homeless, medical home). Foster care could allow resolving isolation problems by offering an adapted place of residence, a helping and available environment, and security. Five interviews were led with six foster families. Well supported by home caregivers, their experience was positive. Neither the nursing care workload, nor the potentially harsh reality of the palliative care represented obstacles for them. They regretted the precariousness of their worker statute and reported a risk of burnout in its current form. Conclusion. - Foster care is a useful and realistic project for patients receiving palliative care, provided that adjustments are made, including employment contracts with the hospital, support by the palliative care unit, possibility of respite hospitalizations and a specific formation. An experiment would be necessary to generalize such an approach. (C) 2017 Elsevier Masson SAS. All rights reserved.