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Dying At Home: People With Terminal Illness Moving Away From 'Institutionalised Death'

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Choosing to die at home is the overall trend in the UK
Choosing to die at home is the overall trend in the UK

More than a fifth of people are now choosing to die in their own homes instead of hospitals, and the overall trend for deaths at home is rising, research suggests.

Experts have long argued that far more people die in hospital than wish to, and it has been estimated that more than 90,000 people in the UK are not having their palliative care needs met.

Now a new study based on Office for National Statistics (ONS) data has found more people are spending their final hours at home despite an overall decline in the number of people dying.

The rise in home deaths appears to be most pronounced among people with cancer, according to the research from experts at King's College London.

The team analysed England and Wales data from 2004 to 2010 and found there were 93,907 deaths at home (18.3% of total deaths) in 2004.

This increased by just over 9% to 102,416 in 2010 (20.8% of total deaths), despite a 3.8% drop in the overall number of deaths between the two periods.

The trend before this was of a decline in deaths at home - the number of deaths at home almost halved from 1974 to 2003.

The latest study also found that while home deaths have increased, the proportion of deaths in hospitals and nursing homes has fallen.

Writing in the journal Palliative Medicine, the experts said home deaths increased for the first time since 1974 among people aged 85 and over (from 17,122 in 2004 to 23,705 in 2010).

Nevertheless, this age group was the least likely to die at home of any adult age group over the study period.

Lead author, Barbara Gomes, said: "What seemed to be an enormous task has happened - the reversal of the British long-standing trend towards an institutionalised dying."

The team said Government policy could be partly responsible for the shift, with more emphasis on allowing people to die in their own homes.

"It is possible that the British policy push towards enabling more people to die at home, including the Government end-of-life care programme (established in 2004) and the national end-of-life care strategy (published in 2008) may be responsible for the trend reversal, alongside other factors."

Despite this, the proportion of home deaths still remains low compared with the US, Canada and some other European countries (such as the Netherlands), they said.

Estimates suggest around two-thirds of people wish to die at home but more than 60% die in hospital.

A 2009 report from the Commons Public Accounts Committee found that co-ordination between health and social care services in relation to end of life care is "generally poor".

It said people cannot always die at home surrounded by friends and family because they are hindered by the NHS and social care system.

Michelle Mitchell, charity director of Age UK, said: "It is good news that the numbers of people able to die at home are rising. We know that many older people would prefer to die at home, in familiar surroundings with their loved ones, than within the confines of an institution.

"However, we are concerned that people over the age of 85 are showing the smallest increase in home deaths when compared with other age groups.

"There needs to be high quality palliative care in place to effectively manage patients' needs at the end of their lives, available to all and not solely for patients who have terminal conditions."

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