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Most people prefer to die where they live but 50% die in hospital

  • 22 Comments

A range of studies that look into the patterns of death in England have been pulled together into one report.

The report marks a moment of progress in the Department of Health’s 2008 End of Life Care Strategy, which says we need more knowledge of the care people are given towards the end of their life.

A wide range of surveys and studies are brought together in the ‘What do we know now that we didn’t know a year ago? New intelligence on end of life care in England’ report.

It highlights concern about care at the end of life, and finds that most people’s preferred place to die is in the place they live, whether that be home, a care home or a hospice. But over 50% of people still die in hospital.

The report says people have an average of two emergency admissions to hospital in the last year of their life, but there is a crucial sub-group of people who are taken to hospital numerous times in their final year. Some of them are admitted more than 10 times.

If the number of emergency hospital admissions was reduced, it would not only lead to better quality and experience of care, but also more cost effective care when the patient does not clinically need to be in hospital.

According to the report, the majority of people who benefit from specialist care services at the end of their life have been diagnosed with cancer, which presents an inequality as more than seven in 10 deaths are not due to the disease.

  • 22 Comments

Readers' comments (22)

  • George Kuchanny

    "According to the report, the majority of people who benefit from specialist care services at the end of their life have been diagnosed with cancer, which presents an inequality as more than seven in 10 deaths are not due to the disease.
    "
    This is a telling sentence. The entire truth is that we all die. Being admitted into hospital as an emergency ten times in a year does not change that one iota.

    Great thought should definitely be given on a person by person basis about the honest effectiveness of zooming a frail person into hospital when an intervention can be just as effectively made at home, e.g. Pain relief or oxygen to assist breathing. Difficult but not entirely impossible to consider.

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  • michael stone

    The percentage of people who achieve a wish to die at home is going up, but rather slowly (although these figures often have a strong element of 'I think I would ..' in them - quite often the people questioned are not actually dying, but are asked 'If you were dying, then ...').

    The main point for all EoL care is the one George made with:

    'Great thought should definitely be given on a person by person basis'

    EoL behaviour is improving, but it needs to be improved further.

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  • DH Agent - as if ! | 12-May-2012 12:12 pm

    you keep repeating yourself and stating what nurses already know which is tedious.

    until resources improve for care in the community the care can't improve - common sense! You can't run the service with insufficient numbers of trained personnel and with insufficient funding. perhaps you would like to start a campaign to obtain these instead of harping on about which just gets people's backs up and achieves nothing. Otherwise leave these columns in peace.

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  • and thanks for being so condescending!

    "EoL behaviour is improving, but it needs to be improved further."

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  • The answer to the NHS problems- come in more than twice a year to hospital and it's Logans Run for you ( or Soylent Green). Saves on the pensions,etc, frees up some space in this crowded land of ours, the list is endless.
    Glad to see Mike Stone back on here giving us his valued, but nonsensical, opinions again after a short absence.

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  • I am a Registered Nurse working as a Ward Manager caring for patients at the End of Life.
    Having looked after my own mum at home, at the end of her life, I can honestly say the process was exhausting and lonely.We had alot of support from our local hospice and macmillan support too but we didn't get night care every night and care in the day was very limited.Here in lies the problem.For those patients who wish to die at home the support needed for those who are caring for that person is immense.The stress and worry it brings can be immense and there just isn't enough support out there to achieve it well all the time. When we recieve a patient onto my Ward for end of life care from home it is very often the relatives who can no longer cope at home.This is a very telling reflection on the committment caring for someone at home at the end of their life requires for these families and is very hard to achieve.
    Having done it and succeedeed,if you like, in giving my mum her death at home, I feel there needs to be much, much more support and resources made available if this ideal is to become a reality and its needed now not tomorrow.For time limited people now is all you have !!!!!!!!!!!!!!!!!!

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  • dying at home is many people's ideal but caring for somebody at home at the end of their life can be daunting and especially when it has to be juggled with other daily living activities of the carers and their families. it is an evolving process which can be very slow or rapid at different stages and many of the outcomes and needs cannot be predicted when taking on such a task therefore adequate professional and other support should be available at every stage.

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  • michael stone

    Anonymous | 12-May-2012 12:41 pm

    redpaddys12 | 12-May-2012 11:40 pm

    Of course you cannot provide more 'treatment' without more resources, but as George highlighted, the question is why are so many dying patients taken into hospital, when 'common sense' suggests they would probably be better off staying at home (even worse, some patients end up in hospital, having made it clear they don't want to leave their home).

    This isn't entirely about lack of resources, it is about decisions which sometimes include a trade-off between 'less' care' but at home, where the patient wanted to die' or 'more 'care' in hospital, where the patient did not wish to be' - but, of course, all nurses already know that, as you point out.

    I am told that EPaCCs will (perhaps) solve the problems, but I'm cynical.

    Anonymous | 14-May-2012 10:52 am

    Your post 'rings bells with me'.

    'Having done it and succeedeed,if you like, in giving my mum her death at home'

    I think your mum had made it clear to you that she wanted to die at home (as mine did) and you managed to facilitate her wish. I am interested in how you think you would have felt, if you had failed and your mum had actually died in hospital ?

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  • Hi DH agent-as if

    Thank you for query via your post and also just noticed my spelling is not great today-apologies to all

    In answer to what you said I really would have felt like I betrayed her as it was her only request to me and my sister(Radiographer in the NHS) and we knew we just had to give her what she wanted.
    Having said that we were very much the daughters and not a Nurse or a Radiographer if that makes any sense.It was just about us as a family doing what we could to give her what she so desperately wanted.
    We were not better at it than anyone else and my heart goes out to those who don't manage to avoid going into hospital when it isn't what is wanted.Bereavement is bad enough without the added burden of guilt too.

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  • michael stone

    Anonymous | 14-May-2012 12:38 pm

    My typing tends to be awful, but what baffles me is why my proof-reading always seems better AFTER sending the e-mail !

    Thanks very much for your reply - my mum wouldn't take prescribed medications and energy drinks, and this effectively forced me to make sure of her position (which was basically 'staying alive is now too burdensome, and I am determined to die at home') but she then became totally non-communicative, then comatose, before anybody else could have asked her 'the question'.

    But that conversation, in my opinion, is transformative - once your dying love done has made it clear to you 'that I want this to happen', I think almost all relatives will very strongly defend those wishes. I don't think relatives will put much value, on the opinions of 'the professionals' if the relatives know their dying loved one wanted something the professionals are not advocating, or didn't want something the professionals want to do.

    This gets very complicated for EoL at home (and a lot hinges on arguing about the law), but in my opinion everyone simply must default to believing that everyone else is being truthful - currently, there is tendency to default towards professionals following a paper-trail of what has been written down solely by other professionals. That is absurd and hugely offensive to 'the amateurs', because usually the people who have the most opportunity to talk to the patient are the live-with relatives, for EoL at home - I am giving 'all and sundry' some serious 'stick' over this. At home, patients can discuss things with their relatives FIRST - this is logically true, yet much guidance ignores that.

    'Having said that we were very much the daughters and not a Nurse or a Radiographer if that makes any sense.' - that makes perfect sense, because as I keep telling people, EoL depends hugely on 'where you are standing'.

    Thanks for not telling me, as some other people on this site invariably do, that I don't know what I'm on about - people can't understand 'what things look like as seen by the relatives' until they have been the relatives, as far as I can work out, and even 'being involved as a DN' isn't necessarily enough to 'get it'.

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