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Nursing service helps terminally ill die at home

Nurses who care for terminally ill patients in their own homes reduce the need for emergency hospital admissions, according to new research.

The Nuffield Trust studied 29,000 dying people and found home-based care by the Marie Curie Nursing Service allowed more people to spend their last moments in their own homes. The experiences of the group cared for by Marie Curie nurses were compared to those of a control group of other terminally ill patients who may have received different forms of nursing.

More than three out of four of those cared for by Marie Curie nurses died at home, compared with just over one in three of those not cared for by the service.

And three times as many people in the control group were sent to hospital as an emergency than those cared for by Marie Curie nurses.

A quarter of the patients involved in the study had never suffered any form of cancer and this group saw more deaths at home and fewer emergency hospital admissions than those with cancer.

The study also found that £1,140 less was spent on hospital care for those looked after by Marie Curie nurses than those in the control group, mainly because they were admitted on fewer occasions.

And the report revealed that the savings on hospital care were larger for terminally ill patients with no history of cancer. It found that £1,475 less was spent on each of these patients compared to a saving of £1,044 for those with cancer.

But the authors of the report said these cost savings could not be looked at in isolation as they did not take into account the amount spent on the Marie Curie Nursing Service or any other services the patients may have accessed as an alternative to going into hospital.

Dr Martin Bardsley, Nuffield Trust head of research, and a member of the evaluation team, said: “In an increasingly tight financial climate for public services, we need to identify models of patient care that maintain or improve the quality and experience of care patients receive without large additional costs.

“The results of this evaluation offer clear evidence of the beneficial impacts of a commonly used package of home-based nursing care for people at the end of their lives. The research provides strong support for increased investment in this area and commissioners should consider these findings.


Readers' comments (3)

  • this is pretty obvious really. what we need to do is train up and employ more palliative care community nurses, it's just common sense. money shouldn't be a factor if a patient needs emergency care, regardless of their life expentancy.

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  • michael stone

    Clinicians seem a little confused about the fact that dying at home is a choice patients have a legal right to exercise, and the level of service provision is something the patient should be considering.

    Obviously I want people to have enough support if they choose to die at home, but if there is less than perfect support (or even no support) it is still up to the patient to decide between dying at home with 'less perfect' medical support, or dying in hospital (where the patient perhaps does not really want to be) with 'more perfect' medical support.

    There are complex non-clinical factors, involved in end-of-life situations - this complexity, is too often ignored or under-stressed within clinically-authored EoL guidance.

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  • I'd love to be a community palliative care nurse - unfortunately our NHS Trust don't do it. We do however have Hospice at Home (However their days are numbered as well)

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