If a death at home is good enough for the Queen, is it achievable for all of us?

Categories: Care.

By Dr Philip Lodge, Palliative Medicine Consultant and Director of Marie Curie hospice in Hampstead and Anna Sebastian, Marie Curie Service Delivery Manager.  

Since the pandemic, there has been an increase in deaths at home. For many this is desirable, but we must remember that a death at home is not always a good death.

Last month Queen Elizabeth II died peacefully at home surrounded by her family. The departure of Britain’s longest serving monarch sparked a period of national mourning and collective grief for many, but it also generated debate in palliative care settings around whether dying at home is something to aspire to, and if it can always be achieved.

The Queen was an exceptional lady, and nobody can deny that her death was an exception. She had personalised care at hand and the financial resources to never have to worry about putting the heating on. But sadly, in 2022, that is not the case for everyone.

Marie Curie’s Dying in Poverty campaign highlights how terminally ill people often plummet below the poverty line following a diagnosis. This can be due to lost income, lack of support and inability to access their State Pension early.

According to recent Marie Curie research, 90,000 people died in poverty in the UK in 2019.  Due to the effects of the pandemic and the current cost of living crisis, we can comfortably assume that, by now, the number is much higher.

It’s a horrible thought to imagine someone dying in poverty, unable to afford food, afraid to boil the kettle or living alone in a cold house waiting for death. Sadly, that is something our nurses and healthcare assistants are seeing more and more.

For the Queen, a death at home was what we would consider a good death. She had her family around her, expert medical assistance and was warm and comfortable. However, for the thousands of people in the UK with no fixed abode, for those living in an abusive household, or for those who simply don’t know how to navigate the healthcare system to access specialist palliative care services, a death at home could be the worst death imaginable.

For those who do not have a secure and stable home life, a death in a hospice, hospital or care home would be preferable and, just because that is not their home, it does not mean their death cannot be peaceful, safe, and surrounded by people who care about them. A good death can be achieved in many settings and that is something we see every day in palliative care.

The Queen’s death is unusual in another way in that it seemingly followed a very short period of illness. In our experience, we have palliative care patients who are accessing Marie Curie services for months, years and even decades before they die.

Dying can be a slow process, and people often need support throughout their journey.  The importance of planning ahead, talking about our wishes and making it clear what we do or do not want cannot be over-estimated and we can imagine this is also something the Queen was able to do.

At Marie Curie we take a holistic approach. Our patients utilise our services in a myriad of ways, from accessing our helpline or bereavement support to being an inpatient in a hospice with 24-hour care.

For people where a home death is both desirable and achievable, Marie Curie can offer support with not just nursing care, medical assistance, physiotherapy, and occupational therapy but also emotional support through our social workers, bereavement counselling and interventions such as art therapy.

Just like life, death is different for everyone.



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