Most people want to die at home, so why do they end life in hospital?

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Posted

June 02, 2017 18:36:45

While the majority of Australians say they would prefer to die at home, they are instead dying in hospital — and often at great expense, a new report shows.

Key points:

  • Report found 70pc of Australians prefer to die at home, but less than 10pc do
  • Issues include what patients want, family wants, doctor’s recommendation, availability of services
  • Report to look at how much taxpayer, Government saves if people die at home

The Productivity Commission, which was asked to look at a range of human services, has released the first of several reports on how best to manage end-of-life care at home, and the services that should be made available to support those who choose to die that way.

“Many of us have parents that are aging, and if we have the conversation with them about what they would like in the last phase of their life, most would say: ‘I want to be at home, surrounded by family and friends’,” Productivity Commission social policy commissioner Richard Spencer said.

“But that doesn’t happen in Australia, it happens very rarely.

“Over 70 per cent would like that at the end of life, [but] less than 10 per cent experience that possibility.”

There are many issues surrounding the subject of where a person should die — including what the patient wants, what their family wants and what doctors recommend.

Why are most people still dying in hospitals?

If most people would prefer to die at home surrounded by family and friends — why is that not happening?

Mr Spencer said Australians needed to start having conversations about death.

“GPs and other specialists need to be able to have those conversations … about: ‘Where would you like the end of your life?'” he said.

“What would you like, what sort of interventions would you like? What sort of things do you not want to happen?”

Who makes the final decision?

In the last minutes of a person’s life, a grey area can emerge in the decision of whether to send a patient home or not.

Documents to make wishes known:

  • Advance Health Directive – a legal document that gives instructions about your future healthcare, appoints a power of attorney and comes into effect when you have impaired capacity
  • Enduring Power of Attorney – a legal document that gives another person the authority to make healthcare and/or financial decision on your behalf when you have impaired capacity
  • Statement of Choices – lists your wishes, values and beliefs but does not form legal consent
  • Wills – a legal document that states how you would like your assets distributed when you pass away

The family may prefer the patient stay at the hospital, or the doctor may advise against the move.

This can make it difficult to decide who to listen to and who gets the final say in the matter.

But it is important for everyone to remember “it is the patient’s choice”, Mr Spencer said.

He said the reported planned to recommend putting the patient in the centre.

“Sometimes they’re not in a position to be able to make that decision — there may be issues like dementia,” he said.

“That’s where the advanced care package, or the advanced care directive, can come in and help the family.”

He said medical staff could also help to establish what was in the best interest of the patient.

“And most importantly, what aligns with their preferences that they’ve been able to express at an earlier time,” he said.

Hospital or at home: the cost

When it comes to the cost to taxpayers and Government, is there a difference between a person dying in a hospital bed and a person dying at home?

“When people spend the last days of their lives in hospital, it’s extremely expensive,” Mr Spencer said.

“So there’s a win-win here in a sense — that people’s preferences can be at the forefront of planning around these services.”

Mr Spencer said the second stage of the report will look into how much taxpayers would save by the majority of people having their final wish of location granted.

“There is a very significant number of people who end up in hospital with very expensive procedures and inappropriate interventions,” he said.

“So there are significant savings to be made there.

“Now those savings can obviously help to offset the investment that we need to make to make sure more Australians get the service, and their preferences realised in their choice to be at home surrounded by family and friends at the end of their life.”

What services are available?

Mr Spencer said services available to people who wished to die at home were very advanced.

“We have some wonderful examples in Australia of how that is done,” he said.

“The care support is there, psycho-social support is there if that’s needed, but most particularly — the palliative care.

“Pain management is an issue that’s foremost in people’s minds and we do some of the best services in the world around that.

“But … it’s just a matter of luck sometimes as to whether you live in the right place, at the right area, where those services are available.”

Mr Spencer said further investment was needed in services.

“One of our recommendations is that kind of expertise … should be much more available,” he said.

“If that’s your choice, that you want to be at home, the kind of support, palliative care that you need should be available.”

Topics:

government-and-politics,

older-people,

health,

death,

community-and-society,

doctors-and-medical-professionals,

aged-care,

australia



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