The majority of Australians would prefer to die at home, but only about 14% get the opportunity to do so, a situation that could be improved with four changes to end-of-life health care, according to a Perspective published in the Medical Journal of Australia.
Professors Hal Swerissen and Stephen Duckett, from the Grattan Institute in Melbourne wrote that dying in Australia was now "highly institutionalised".
"Fifty-four percent of people die in hospitals and 32% in residential care ... [even though] between 60% and 70% of Australians would prefer to die at home", they wrote.
"Dying is not discussed, and we are not taking the opportunity to help people plan and prepare for a good death."
A "good death", they wrote, was one in which the patient had choice about who would be present, where they would die, what services they would get, and one in which their symptoms were well managed, with personal, social and psychological support, and that they would have the opportunity to say goodbye, and leave "when it was time to go without pointlessly prolonging life". Swerisson and Duckett proposed four reforms which would facilitate a good death:
- Have more public discussions about the limits of health care as death approaches, and what people want at the end of life
- Translate public discourse into personal choices - people need to plan better to ensure their wishes are complied with
- Ensure that if patients have expressed wishes about the care they want at the end of life, those wishes are followed
- Reorient services for those dying of chronic illnesses so that they focus more on people's wishes to die at home and in homelike settings, rather than in institutions
They suggested a public education campaign focused on encouraging people to "discuss their preferences and choices for end-of-life care with health professionals, including general practitioners".
Trigger points for mandatory discussions with health professionals could be introduced, including:
- During health assessments for people aged over 75 years
- For all residents of aged care facilities and for high-needs recipients of home-based care packages
- For all hospital inpatients who are likely to die in the next 12 months
From an economic point of view, Swerisson and Duckett concluded that the costs of a national education program ($10 million) and the cost of extending the availability of community packages to enable 30% of Australians to die at home (an additional $241 million) would be offset by reduced demand on hospital and residential aged care services, to the tune of an overall saving of $50 million, resulting in a net cost of $84 million.