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Physical
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• Bringing the hospital to home -Diminished space and overcrowding in communal living areas because of equipment and supplies from hospital can result in risk of trips, slips, falls, from equipment like wheelchairs/walkers, lifting equipment, and tubing, which can cause unintentional physical injuries)
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• Limited training in medication storage, administration, side effects, and contraindications of narcotic medications and paraphernalia in the home, which is used in end of life care
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Emotional
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• Concern for caregiver well-being when taking on caring responsibilities, as well as implications associated with burden placed on caregivers
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• Fear of hurting the client when using equipment they do not feel adequately trained to use
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• Disease trajectories with unpredictable setbacks and often with sudden changes and/or exacerbations of disease
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• Dealing with a multitude of intense life-altering situations that can change quickly, which are often urgent, unexpected and unpredictable
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• Wish for a dignified death at home can result in either a conscious or unconscious failure to recognize safety risks for themselves or others in their home
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• Fatigue as a result of being on duty 24/7, constant change, & uncertainty, and a lack of routine
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• Grief and emotional distress because of caring for a dying loved one
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Social
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• Client’s terminal illness and minimal social network lead to a feeling of conscription and the expectation that spouses, ex-spouses, siblings, and children will help, leads to a renegotiation of roles
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• Pre-existing health challenges (physical & mental) are worsened when roles are renegotiated, leading to reciprocal roles being determined by who is the sickest at the time
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• Pre-existing tensions amongst client, family/friends, and old wounds re-opened
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Functional
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• Client loss of dignity (due to incontinence) in public places
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• Compelled to take time away from work or other activities
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• Diminished capacity for self-care, employment, engagement with family, friends, outside world
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• Learning to be a caregiver on the job with limited support
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• Developing ‘home grown’ solutions placing both parties at risk
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• Inability to recognize if something is wrong because never told what to look for
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