Choosing where to die

If If asked, many people say they want to die at home. This may be because they want to be around familiar surroundings and people.

While this option is not for everyone, if you do want to be at home, support is available. This may vary from a few hours a week, to a few hours a day, to 24-hour care (although 24-hour care involves high additional costs). You may have to modify your surroundings (e.g. handrails) or buy special equipment (e.g. shower chairs).

Your GP, nurse, palliative care specialist or palliative care nurse practitioner can help you arrange this support. They can suggest services to manage symptoms such as pain or breathlessness. They can also teach carers how to assist with day-to-day activities such as bathing and eating. Even if you live alone, with planning, you can stay as long as possible in your own home. See My Aged Care for more information and to see if you are eligible for government-subsidised support services.

Some carers may find having you nearby easier. It may mean that they don’t have to travel, or fit in with a hospital or palliative care routine. Caring for someone who is dying at home can be a meaningful experience, but it can also be challenging. For more information, see Caring for someone who is dying.

You can decide at any stage to change your mind about staying at home and explore other options. If you are planning to stay at home until the end, talk to your GP or palliative care team about ways of dealing with unexpected medical events.

A palliative care unit is a specialised palliative care facility. It is sometimes called a hospice, and may be a standalone facility or rooms within a hospital.

The focus at a palliative care unit is on caring for people with a lifelimiting illness and maintaining quality of life. They are run by health professionals who specialise in providing physical and emotional comfort to the patient, and supporting family before and after death.

Palliative care units and hospices are different from most hospital wards. They are usually quieter and calmer, and may have a more homely environment. Many people value the relaxed surroundings, as well as the skilled staff and expert symptom management. Sometimes you can go back and forth between a palliative care unit and another setting during your final weeks. Many facilities now have a maximum length of stay, so you may want to check this with them ahead of time.

You may choose this option if you have complex needs or can’t be cared for at home. Your family and friends can still be involved and visit you to provide care. They may want to help with meal times or bathing or just be there for company and support.

Some people are unsure of when to contact a palliative care unit. They may wait to call until the final days, possibly missing out on the support that the palliative care unit has to offer.

Some facilities have waiting lists, and often base their intake on people who have the highest level of care needs, so talk to your doctor or palliative care team early about how you can make arrangements and when it would be an appropriate time to make the first contact.

Even when death is expected, more people approaching the end of life die in hospital than anywhere else. While some people and their family feel more secure being near health professionals, others feel anxious about hospital care, believing it will be too impersonal.

If you have spent a lot of time in hospital during your illness, you may want to stay on the same ward where you are familiar with staff and surroundings. You’ll need to check if this is possible – sometimes people are moved to a different ward as their medical needs change. To help create a more homely environment, ask if you can bring in familiar items from home, such as a favourite blanket or photos.

Hospitals sometimes provide medical interventions, such as resuscitation and intravenous drips, that may not be what you want in the final weeks or days of life. Talk to your team to make sure your care plan matches your preferences. Let the hospital staff know what interventions you are comfortable receiving and what you’re not happy to have happen.

End-of-life care in a hospital can be managed with communication and advance care planning. You can arrange to have your preferences and wishes recorded in advance care planning documents before an emergency occurs. It’s a good idea to keep a copy at home so your family, friends and carers know your wishes too.

Dying in hospital may mean you are able to donate your organs or tissues. Talk to your family in advance about whether you would like this to happen as the hospital will still need their consent. Visit DonateLife for more information.

A residential aged care home (formerly called a nursing home) is a place for older people who need continual care and help with daily living. These homes cater for people with a range of chronic conditions, and nurses and aged care workers can provide ongoing care. Some aged care homes also provide respite care. For a list of government-subsidised aged care services, see My Aged Care.

Some people fear that dying in residential aged care will be unpleasant and perhaps impersonal. But dying in an aged care home can be comforting, particularly if you have been there for a period of time and you are familiar with the people there. Staff will try to make you comfortable and give you and your family privacy.

If you want to die in a residential aged care home, consider making an advance care document so that staff know your choices and preferences about care and treatment. Talk to your care providers about avoiding an unnecessary transfer to hospital at the end of life.