Practices and Perspectives on Dying at Home in Norwegian homecare services – a secondary analysis of qualitative data

Background: There is increasing recognition that individuals of all ages with life-limiting conditions benefit from palliative care. Despite a preference for dying at home, most patients still spend their final days in hospitals. WHO encourages member states to integrate palliative care across all levels of the health system. European Association for Palliative Care (EAPC) Atlas 2025 suggests increasing service availability by prioritizing home-based and community-integrated models within palliative care, highlighting that these strategies enhance symptom management, alleviate pressure on health systems, and honor patient autonomy. Aim: To explore how home care services in a Norwegian municipality implement practices that enable patients to die at home, and how healthcare professionals experience these practices. Methods: This study applied a secondary analysis of data collected for an evaluation of a structured care model for home time and death implemented in a medium-sized Norwegian municipality. Data were collected through focus group interviews with participants from the project team who had developed the model, home care unit managers, and healthcare workers involved in applying the structured care model in practice. Results: The analyses resulted in the following three themes describing how home care services implement practices enabling patients to die at home as well as their experiences of this practice: I) Advancing palliative care through focused projects: enhancing competence and addressing challenge; II) Spending the final days at home: identifying the palliative patient and providing compassionate and effective care, and , III) Sharing responsibility versus taking the load of: Fostering knowledge and support in home based palliative care. Conclusions: Findings in this study indicate that implementing a structured palliative care model facilitated a more targeted approach to care delivery. The implementation process illuminated both strengths and weaknesses of existing practices in enabling patients to die at home. These included relationships to patients and their families, collaboration among care staff, organization of services, and cooperation with other agencies. Overall, advanced care planning and peer support are seen as essential to deliver high quality palliative care.