Dying well

by Hal Swerissen Stephen Duckett

Seventy per cent of Australians want to die at home yet only 14 per cent do so. Despite their wishes, about half of people die in hospital and a third in residential care. Dying in Australia is more institutionalised than in most countries. Medical and community attitudes plus a lack of funds for formal, home-based care mean that Australians die at home at half the rate that people do in New Zealand, the United States, Ireland and France.

More than at any time in history, most people die when they are old, and are more likely than past generations to know when in the near future they are going to die. That gives us a great opportunity to help people plan to die well. Policy and attitudinal change could enable more people to die comfortably at home and in home-like environments, surrounded by family, friends and effective services.

Dying Well finds that because most people do not speak up about the way they would like to die, they often experience a disconnected, confusing and distressing array of services, interventions and relationships with health professionals.

The report recommends more public discussion, including an education campaign, about the limits of health care as death approaches and the need to focus on end-of-life care.

It also proposes the widespread adoption of advance care plans that ensure people’s desires for the end of life are met. Finally, it recommends greater investment in community-based care to enable services for those dying of chronic illness to shift their focus from cures and institutional care to supporting people’s wishes to die at home.

Doubling the number of people who die at home will cost $237 million a year, but about the same amount of institutional care funds could be released to pay for it.

The baby boomers are growing old and in the next 25 years the number of Australians who die each year will double. We need the courage to promote a discussion about a subject that we might dislike but cannot avoid.

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