The choice to die at home: a reality or an aspiration? Does hospice at home hold the key?

Categories: Care.

While the Economist Intelligence Unit study of palliative care provision in 80 countries praised the UK’s NHS and hospice movement for providing care which is “second to none”, the NAHH shares the stance of Claire Henry, chief executive of the National Council for Palliative Care (NCPC), who emphasised the importance of not becoming complacent – especially with the rising demand for quality palliative care.

In her keynote speech at the recent NAHH conference, Henry spoke about choice and the current work of the NCPC. Indeed, there continues to be a considerable amount to be achieved – in particular for our frailer ageing population who may well have several co-morbidities.

The member services of the NAHH are very aware of this and are developing services in response. A number of these developments were showcased through the posters on display at the conference.


People may die in their own home, care home, hospice or hospital, however the timing of when choices are considered and decisions made is critical to achieving the desired outcome. It is also critical in ensuring the person dying has the support of those they love around them and the professional support at the “right dose” to enable this.

NAHH member services understand this and are often involved in enabling care in an environment of choice until the person, for whatever reason, moves into a hospice or hospital environment, for example – depending on the individual circumstances and resources required.

Research published last week suggests there are four key messages when considering if home is the best place for someone to die.

However, at the time people say they wish to die at home, it is significant to consider whether they are actually facing a life-limiting illness, or postulating on something when they are reasonably well and may have limited insight to what may lie ahead for them?

Do they have any idea what may be necessary to enable them to be where they would want to be?

While acknowledging the cohort of people known to hospice at home services have awareness of their life-limiting illness, they ultimately do benefit from services’ expertise in opening up important conversations with dying people and their families.

Discussing choice and reality of what can be offered and provided to people facing the end of their lives is routine to hospice at home care services.

Often services will tailor an approach to care in conjunction with several other providers and family carers to enable actual preferences and choices to be achieved – many hospice at home teams will have very high percentages of enabling home death where this is the chosen place.

What is fundamental though, is the open communication and shared decision making of those who have a part to play in achieving what is aspired for.

Home vs hospital

Will hospital remain the place where most people die, as Pollock suggests? Or does significant investment in community resources and expert providers of palliative and end of life care have a part to play?

Having recently met with a commissioner who encouraged the repeating of small successes to effect a bigger impact and influence of positive results, is there something to be learnt from (and built upon) how successful hospice at home services are enabling home death?

Recently Marie Curie launched a new advertising campaign, highlighting night care services for people dying at home. 

The NAHH sees the importance and difference having night care can bring to family carers – this is one element of care which may positively impact on the success of achieving someone’s choice at the end of life.

Meeting with many of our members from services across the UK at our conference event in Leeds, the NAHH are mindful of the vital difference having night care can make to some families in sustaining their loved ones at home when dying.

Delegates were invited to display posters about their work, focussing on the conference theme of the potential key that many hospice at home providers may hold in enabling high quality deaths at home.

The posters were inspiring and encouraging and shared innovations around partnerships, collaboration, co-ordination, rapid response teams, enhanced support, acute hospital admission avoidance, volunteers, flexible and integrated services.

At Mary Ann Evans Hospice, our hospice at home service also provide much needed night visits, and our family carers often tell us how much they value and appreciate the care services provided. This is a common theme, I’m sure, heard by NAHH member services as well as other providers of palliative and end of life care in the UK.

Community nursing

Barbara Gomes from the Cicely Saunders Institute hopes that her recent research will “prompt policy makers and clinicians to improve access to comprehensive home care packages including specialist palliative care services and 24/7 community nursing.”

Here is another crucial element of successful care at home – community nursing.

Many NAHH member services have expressed concern about the turbulence and strains of community nursing, which massively impacts on the level of care their services are then expected to provide as charitable organisations.

Speaking at our conference, Jane Cummings, chief nursing officer for England, was able to offer some reassurance to delegates that national workforce planning was giving serious regard to community and registered nursing workforces required for the future.

The future of where people die can be changed. We have the knowledge, skills and attitudes to effectively enable this. Success, however, is reliant on everyone involved from the array of domains in health, social and third sector and our public to achieve this. 

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