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Care homes could overtake hospitals as most common place to die, new research finds

Author: Suzanne Stevenson
11 October 2017

Researchers from King’s College London have found that deaths occurring in care homes in England and Wales could more than double in the next 25 years if recent trends continue.

They argue that investment is urgently needed to ensure all care homes are prepared to support residents as they reach the end of their life. Without significant investment, they believe that the extra deaths are likely to occur in hospital instead.

In a paper published today in Palliative Medicine, the study shows that the number of people dying in care homes is increasing, while the number of people dying in hospital declines. Death at home is also slightly more common. This is in line with most peoples’ wish to die in the place they usually live.

Using official mortality data on over 5,500,000 people and population forecasts, the researchers quantified future increases in the number of people dying in different settings, to help guide planning of health and social care. 

From 2004 to 2014, the proportion of deaths that occur in care homes increased from 17% to 21%, with numbers rising from 85,000 to 106,000 per year. 

If this trend continues, the number of people dying in care homes will double to nearly 230,000 per year by 2040. In this scenario, care homes will overtake hospitals as the most common place to die.

“The projected rise of deaths in care homes is striking and warns of the urgent need to ensure adequate bed capacity, resources and training of staff in palliative care in all care homes in the country”, said lead author Anna Bone, researcher at the Cicely Saunders Institute, King’s College London.

“If we are to continue enabling people to die in their preferred place, it is essential to invest more in care homes and community health services. Without this investment, people are likely to seek help from hospitals, which puts pressure on an already strained system and is not where people would rather be at the end of their lives”.

Professor Irene Higginson, Director of the Cicely Saunders Institute at King’s College London and senior author of the paper, added: “This study shows that end of life care will become the core business of health and social care services in the near future. We need urgently to prepare for this.

“We must ask care home and community services whether they are equipped to support such an increase, and provide care of quality. Will they be able to get the workforce needed?  The time has come to test new approaches, such as innovative palliative care models in care homes and the community, to ensure we address this growing need which will affect us all, directly and indirectly, in the years to come. Otherwise we will be faced with more deaths in hospital, or poor quality end of life care or both.”

Commenting in response, Carole Walford, Chief Clinical Officer, at Hospice UK said:

“The predicted steep rise in deaths in care homes draws attention to the urgent need for more training for care home staff in palliative and end of life care.

“Many hospices are working in partnerships with care homes on training and education programmes to help develop the skills and knowledge involved in providing end of life care.

“Greater investment to grow these skills among care home staff will enable more people at the end of life to be cared for in familiar surroundings by those that know them well. It will also help reduce inappropriate admissions for people approaching the end of life to overstretched hospitals.”

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