Where we want to be cared for and die is a question that many of us probably haven’t thought about yet. Yet in the next 20 years the number of people dying in Scotland will increase by 16 per cent in 2040, according to projections from the Office of National Statistics. Nearly half of all those who die each year will be aged 85 or older.
As co-author of a new study published in the BMC Palliative Care we’ve shown that if current trends continue, up to two-thirds of deaths in Scotland could take place outside of hospital, either at home, in a care home or a hospice. Hospital will remain the most common place to die, but significantly more people are projected to die in the community than they do now.
This will require more healthcare professionals in the community. However, currently across the UK there are not enough people to fill health and social care roles currently advertised. Unless the workforce expands, it is likely that many people who would choose to die at home will instead die in hospital without adequate home care support.
Alternative solutions to providing care at home to an increasing number of people are urgently needed. Digital technology, in particular videoconferencing, could play a significant role in providing timely access to palliative care at home and in care homes. While face to face contact will remain a core element of palliative care, an increasing number of consultations are likely to take place online. Video-conferencing is also increasingly used to connect care home staff with palliative care specialists in other settings to enable education, training and support.
Family and friends provide vital care for people who choose to spend their final months at home. This can include helping with medications, providing personal care among other tasks.
As people live longer, carers are getting older, especially partners or spousal carers, and will have health concerns of their own.
To support more care in the community in the future, healthcare professionals will need to work more closely with family carers; assess their needs alongside those of the person with advanced illness, so that the carer is well supported to care for their loved one while at the same time preserving their own health and wellbeing.
Dying, death and bereavement are social and cultural experiences involving all of us, not only health and social care professionals.
Initiatives like Compassionate Communities are crucial where caring for one another at times of need, loss and crisis becomes the task and responsibility of everyone.
Neighbours can play a vital role by checking on people who are socially isolated as a result of advanced illness. Help with practical tasks such as shopping, collecting medicines, transport or just sitting with anyone who may be worried or on their own, can be a lifeline.
If Compassionate Community initiatives are supported to grow over the next decade, more people will have the opportunity both to provide care to others and to be cared for in their own community.
For anyone approaching end of life, starting a conversation with family, friends and professionals about the future, including where you would like to die, can really help.
For many, this may be daunting or distressing, but it can also be a relief. Anxieties can be addressed, decisions can be made and plans shared, so that everyone is better prepared for the future.
Not talking about death can create tensions and increase social isolation and loneliness. Marie Curie offers a wide range of online resources to help people who would like to plan ahead. Our Talkabout booklet provides information on starting a conversation about dying, death and bereavement and our website has short videos and blogs describing the experiences of people approaching end of life, as well as their family and friends. While we can’t absolutely predict the future, given the age profile of the Scottish population we can be certain that more people will need palliative and end of life care in the next twenty years.
Thought is now needed on how to help people spend the last period of life in their usual place of residence and that their care is consistent with their wishes.
Anne Finucane is a Marie Curie research lead. mariecurie.org.uk