Dying at home

Figures from a survey carried out in 2013 by the Office for National Statistics showed that 85% of those who died in hospital that year had wished to die at home. Now, the amount of people dying at home is at the highest it’s been for 12 years. With a growing trend for dying at home and the rise in people carrying out their stated preferences for their own end of life care, it seems that more and more people are taking control of death. Here’s a look at the ways in which it’s possible to plan for dying at home, and what options for care to expect.

Are fewer people dying in hospital?

The number of people dying in a nursing home has also risen, by 5% between 2004 and 2012, taking the total to 21.8%. Many hospices, too, are now more used to people dying in their care. As the chief executive of Marie Curie Dr Jane Collins has said, while around 50% of those who die each year do so in hospital, there’s often ‘no clinical need for them to be there’.

Starting that conversation about death with those close to you can be unsettling and hard. Once the subject is tackled initially, death will come to seem the most natural topic, especially if you’re getting older or have received a terminal illness diagnosis. By thinking ahead you can make sure you don’t compromise on living out your last days.

What is good end of life care?

The key focus when it comes to dying at home should be on getting the proper support in place. While it’s obvious that a large portion of people find the prospect of dying in a familiar setting such as home a comforting thought, sometimes it may not be the best option. Your home might not be the most suitable place. It may be too large or have too many stairs. Or, it may be that the person you want to care for you won’t be able to do it alone.

If you would like to give it a go then here’s some aspects of good practice when it comes to getting care outside of a hospital:

• • You should be seen by a doctor regularly and if they believe you will die very soon, they must explain this to you and the people close to you.

• • The staff involved in your care should talk sensitively and honestly to you and the people close to you.

• • You and the people close to you should be involved in decisions about how you are treated and cared for, if this is what you want.

• The needs of your family and other people close to you should be met as far as possible.

Getting support at home

Wanting to die at home means making sure you are at the centre of decisions about your care. Your main point of support will be a GP and district nurse and, as it’s more popular among those with cancer, dying at home has become more viable due to the help of community nurses and hospice professionals.

Your GP can arrange for support from community nurses to visit you at home. There are also specialist palliative care nurses who can make home visits. Palliative care nurses often have the knowledge of specific illnesses as well as the best ways in which to make the dying process more comfortable.

This sort of support can:

• • Provide hands-on personal care; from washing to mobility help

• • Advise those around you on how to maintain pain control

• Provide emotional and practical support for carers

The kind of support offered for living out your final days at home can take the form of respite care or just some extra hands on deck during a difficult time. It is also possible to get nursing care 24-hours a day.

Hospice care while staying at home

While you may want to live out your last days at home, you can also visit a hospice during the day a few times a week to get the support you need. This is an option if you haven’t got a network of carers around you, or they can’t help everyday. At a hospice you can get further treatment and therapies such as exercise programmes, as well as the opportunity to socialise.

You could also go for the hospice at home service. This is hospice type care delivered to your door. A GP, hospital professional or community nurse will need to refer you to a hospice at home service so you can get free access through the NHS or a charity.

Helpful services  

Caring for someone who is dying? Visit the Marie Curie page dedicated to supporting carers.

If you want to know more about getting a Marie Curie nurse at home, read their page here.

Age UK advice run a free national information line on 0800 169 6565. It’s open 365 days a year from 8am to 7pm.

Macmillan has its own information and help line as well as helpful online resources.

Visit our support page for more information on general support.

Your death preferences

Decisions surrounding your death should be informed by what the best thing to do is in your individual situation.  An article in the British Medical Journal warns that there shouldn’t be an assumption that an individual’s home is always the best place to die.

The article argues that more emphasis should be put on improving how people are cared for at the end of their life in hospitals. This is something to think about if you’re dead set on dying at home but come up against complications which may not make it possible.

Whichever way you want to go out (and, ultimately, it might be that some of us won’t have the opportunity to get a say in the matter) you must put it down in writing. Whether it’s a will or an advanced statement, make sure your preferences are known.