Terminally ill need not die in hospital, says study

The number of people dying in hospital could be substantially reduced through the provision of more hospices or specialist care at home, according to a new report.

Wide variations in access to care for the terminally ill exist across different regions, according to the report.

Despite high overall levels of satisfaction with services, patients had a preference for palliative care delivered in specialist units over hospital care.

Costs were similar in different areas of the country, despite the differences in the level and type of services provided, the researchers from Trinity College Dublin and the Economic and Social Research Institute (ESRI) found.

The study, which looked at palliative care services in the HSE midlands, midwest and southeast, found not all areas had access to specialist palliative care inpatient units, daycare centres or hospice care. Availability of services varied from 24 hours a day, seven days a week, to office hours only.

Access

Most people and their carers reported getting access to specialist units was easy but getting access to a hospital bed was much more difficult

The quality of inpatient hospital care was rated lower than specialist services or hospices, particularly in relation to emotional support for families.

In the midwest, the only area where both options were available, the hospice scored much higher than hospital care on every quality measure.

Older people were generally the primary informal carers of those who were unwell, except in the southeast where adult children provided the largest proportion of care. The majority of all carers in all areas were women aged 35-64.

The study noted how patients’ preferred place of death changed with time. Six months prior to death, most wanted to die at home; but, by the last week of life, this proportion had decreased.

Researchers said this probably reflected a person’s increasing level of need and their wish not to place this burden on family members.

Almost 75 per cent of people died in the place they or their carer believed they preferred to die in their last week of life.

The cost of palliative care in each region was quite similar despite the variations in the services being provided. The average total cost of formal care in a person’s last year of life ranged from just over €40,000 in the southeast to €50,000 in the midlands and midwest.

Trinity College professor Charles Normand said older people needed to be thought of as a resource and providers of services, as well as people needing care. “It is also important to understand that the provision of formal care does not lighten the load of informal carers, but does allow them to use their time to address the wider needs of their relative,” he said.

“Evidence from this study shows that more developed palliative care reduces the costs of other health services. While overall savings are probably not achieved, much of the cost of palliative care can be paid for by savings from hospital care.”