Unfortunately, according to the Grattan Institute, the reality for 54% of Australians is they die in hospitals. 32% die in residential care. Only 14% get their wish to die at home.
This makes dying in Australian more institutional than much of the rest of the world. People in the United States, New Zealand and France are more likely to die at home. In a hospital people are more likely to die while feeling lonely and disconnected. They are in an impersonal institutional situation. The staff and machinery give them lingering, sad deaths.
The situation continues to worsen because the baby boomer generation is now reaching 65 years old and beyond. Demographers predict the number of Australians dying every year will double over the next 25 years. That means the rate of deaths will increase a lot faster than the nation’s births.
People are now more likely to live into old age than to face a sudden, unexpected death at a young age through war, accident or communicable disease. They are more likely to know their end is approaching because they have a chronic disease, but the Australian medical system does not help them plan ahead to die at home.
Dying at home requires more than just supportive family and friends. It requires medical equipment, medicine and someone to administer palliative care. Instead, the elderly approaching the end of life face a confusing number of choices and interactions with medical professionals which do not lead to open planning for the end of life.
This is a major shift in the past 100 years. Partly it reflects how medical care in hospitals has improved. Years ago they were institutions where people went to die. That’s why the middle classes and the wealthy preferred to remain at home, served by doctors who still made house calls. You see that in movies made in the 1930s. In the aftermath of World War II hospitals became safer places to receive treatment.
However, that change in attitude resulted in hospital care even for people who do not suffer from treatable conditions, but from the end of life. In the 10 years ending in 2012, hospitalization rates for men over 85 years old increased 45% and by 35% for women in that age group.
Ideally, given the choice, people want to die at home in a situation meeting their physical, social, personal and spiritual needs.
According to the surveys, only 19% of people would choose to die in a hospital and only 10% would choose a hospice. Only 1% would choose to die in a nursing home.
The Grattan Institute report gives many characteristics of a good death, assuming someone does know death is approaching. For most elderly people these days, that is true because they are suffering from chronic, lingering diseases.
People wish to retain control over what happens with them. That includes their choice of location, whether it’s a hospital, hospice or at home. They wish their family and friends present. They wish emotional and spiritual support.
They deserve their dignity and their privacy, and yet need access to medical expertise and care. Their need medical control of pain and other symptoms. And a good death includes the right to hospice care even if the patient is in a hospital or at home.
They have the right to control who is present at the end.
Out of the entire $100 billion healthcare budget in Australia, only $100 million goes for helping people die at home. As more baby boomers see death approaching, they and their families will begin pressuring for a shift in budget priorities. Money could be shifted from funding death in hospitals to helping people meet their end at home, changing the patterns of death and dying in Australia.
I think assisted dying will become a very acceptable pathway for many. This is also problematic as people suffering from dementia cannot access this process and religious beliefs may be a barrier. The nature of family and community has changed dramatically over the past few decades with the additional pressure of people living longer and wanting to remain independent. This has resulted in many aged and ill people becoming isolated and unable to access care they would prefer. We are not geared to deal with the deluge of older people requiring care. Factors include 1) Economic 2) Societal change / in my younger days it was usual for grandparents to move in with their children in order to access care 3) People are living longer 4) People have higher expectations 5) Many older people struggle to navigate technology requirements to maintain their independence. I am not hopeful that there will be solutions as I dont think finances are there and even self sustaining older folk find their savings eroded by inflation. Interesting times ahead! Maybe AI and robotics will alleviate some of the pressure.