Terminally ill more likely to die at home with specialist care

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Patients who receive end-of-life care at home are less likely to need emergency hospital treatment than those who do not, claims new research.

Such patients are also significantly less likely to die in 
hospital, according to the new study.

Researchers from the Nuffield Trust examined almost 60,000 terminally ill patients, half of whom received care from the Marie Curie nursing service.

While 12 per cent of those who received the service were admitted to hospital as an emergency prior to them passing away, more than three-quarters (77 per cent) of those who used the service died at home.

But of the patients who did not use the service, who were in a control group, only 35 per cent died at home.

Eight per cent of the Marie Curie patients died in hospital compared with two-fifths of the patients who did not receive the care-at-home service.

In its findings, the Nuffield Trust said: “These results offer evidence that home-based nursing care can reduce hospital use at the end of life and help more people to die at home.”

Dr Jane Collins, chief executive of Marie Curie Cancer Care, said: “Most people want to be cared for at home at the end of their lives and don’t want to spend their final days in 

“We now have strong evidence to show just what a difference the Marie Curie nursing service care can make to fulfilling people’s last wishes. Unfortunately, the provision of good quality of end-of-life care varies greatly and not everyone is able to access services. Our priority is to work with commissioners to ensure they understand the end-of-life [care] need and provision in their area.

“It is only by ensuring we get more people out of hospital and into more appropriate care that the government will be able to meet the twin challenges of an ageing society and ongoing 
economic pressures.”

The Nuffield team described the findings as “striking” given that more than half of all deaths occur in hospitals and only about a fifth take place at home, despite surveys showing that the majority of people would prefer to die at home.

It also said that end-of-life care is often associated with cancer patients but the study highlighted how the service benefited other patients with a range of illnesses, or none.

The study also found dying at home saved an average £1,140 in hospital costs – but the researchers highlighted how this cost saving would need to be offset against other costs, including funding home nursing care.

Dr Martin Bardsley, Nuffield Trust’s head of research, added: “In an increasingly tight financial climate for public services, we need to identify models of patient care that maintain or improve the quality and experience of care patients receive without large additional costs.

“The research provides strong support for increased investment in this area and commissioners should consider these findings.”

The Nuffield Trust provides independent research and policy analysis for improving health care in the UK, with particular expertise in the evaluation of community-based healthcare.