Can someone really die at home with proper medical support?
Yes.
Yes. Some people can die at home with good medical, nursing and family support. It is not possible or safe for everyone, but it can work when the person wants it, symptoms can be managed, and carers have clear help to call on.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
What makes dying at home possible
Dying at home usually depends on more than one thing. The person needs a doctor or palliative care team who knows their situation. The carers need to know who to call during the day, after hours and in a crisis. The home may need equipment, medicines and a plan for what to do as the person becomes weaker.
The Australian Government says home palliative care depends on the illness, the amount of care needed, support from family and community, and whether someone at home can provide physical care. CareSearch gives similar advice: many people can be cared for at home, but some people need specialist palliative care or a stay in hospital or a palliative care unit when needs become complex.
The aim is not to make family carers act as nurses. A safe home plan should say what carers can do, what nurses or doctors will do, and when the plan needs to change.
What medical support may look like
Home support may include:
- a GP who remains involved and can visit or give advice
- community nurses or specialist palliative care nurses
- a palliative care doctor or specialist team, when needed
- medicines for pain, breathlessness, nausea, agitation or other symptoms
- equipment such as a hospital bed, pressure mattress, commode, shower chair or walking aid
- advice from an occupational therapist, physiotherapist, pharmacist or social worker
- an after-hours contact plan
Not every person needs every service. Needs can also change quickly. Someone may be able to stay at home for months, then need a short hospital or hospice stay to settle symptoms, then return home. Moving to hospital does not mean the home plan failed. It may be the safest way to get control of a problem.
The carer's role
Family and friends often do much of the day-to-day care. This may include helping with washing, toileting, meals, position changes, medicines, comfort, phone calls and appointments. That can be a lot, especially if the person becomes bedbound or confused.
Before deciding on home care, ask the team:
- what care is likely to be needed in the next few weeks
- whether one person can manage it or whether a roster is needed
- what help is available overnight
- whether carers will be taught how to give medicines safely
- what equipment can be brought into the home
- what to do if symptoms suddenly worsen
- what would make hospital or hospice care safer
If the main carer is exhausted, unwell, frightened or unable to lift and move the person safely, the plan needs review. Carer Gateway may be able to help carers with counselling, respite and practical support.
Planning for an expected death at home
If the person wants to die at home, talk early with the GP or palliative care team. Healthdirect advises that a person planning a home death should have an appropriate plan. This may include "death at home" documents, such as a letter for ambulance staff saying the person is expected to die and should not be resuscitated if that is their documented choice.
The plan should also cover:
- the person's wishes about resuscitation and hospital transfer
- who can make decisions if the person cannot speak for themselves
- advance care planning documents, if the person wants them
- who to call when death is near
- who to call after death
- the funeral director, if one has been chosen
Advance care directive forms and rules vary between states and territories. If a directive is needed, use the correct form for the person's state or territory.
When home may not be the best place
Home may not be safe or possible if symptoms are severe and cannot be controlled there, carers cannot provide the needed care, the person does not want to be at home, the home environment is unsafe, or services are not available quickly enough.
This can feel disappointing, but the place of care can change. A person can still receive palliative care in hospital, a palliative care unit, hospice or residential aged care. The main question is where the person can be cared for safely and respectfully at that time.
When to get help now
Contact the person's palliative care team, GP or community nurse if pain, breathing, agitation, vomiting, bleeding, confusion or distress is new, worsening or worrying you.
Call 000 if the situation is serious and urgent, such as an unexpected collapse, severe uncontrolled bleeding, a major injury, fire, danger to others, or if you have been told to call 000 in that situation.
If the death is expected and there is a home death plan, follow that plan. An expected death at home is usually not an emergency.
You may also want to read
- What support is needed for someone to die at home?
- What happens immediately after someone dies at home?
- Do I need to call 000 or the police after an expected death at home?
- When should palliative care start?