Many discussions take place nowadays about our preferred place of care in our final days of life. I’ve already written down my own preferences and had conversations with my nearest and dearest about this.
In my book, Moments of Meaning, I list the options for a preferred place of care. These include:
- Our own home
- A relative’s or friend’s home
- A nursing or residential care home
- A local hospice
- A local hospital
There are many factors that impact on our preferred place of care including:
- Management of our symptoms and access to/administration of medication
- Access for relatives and friends
- Control and comfort of our environment
Each person’s circumstances and symptoms in the last phase of life are unique to them. Therefore, each person’s preferences will also be unique. There may be a perception that dying at home is the preference of most people. When asked in surveys, this is usually born out by statistics. However, given the various factors that impact our preferences as we approach our last days, the situation is very often complex and preferences can change.
My experience says that if we have done the research on what’s available in our locality, we have the information to list our preferences in order of priority. It’s also helpful to add the reasons why we’ve chosen our order of priority. This can really help us and relatives make quick decisions when the time comes. If we have expressed only one place, if for whatever reason this isn’t possible, this can leave relatives feeling they’ve failed us.
My Top Preferences
My top preference is to be cared for at home if my symptoms are manageable. I’d only be able to do this if relatives, friends, health professionals and/or paid carers are willing to support me. In this environment, I have the best chance of managing things in the way I choose. If I’m already living in a residential nursing home and the staff can continue to care for me, I’d prefer to stay there. This would feel comfortable and like my home.
If neither of these are possible or my symptoms are really difficult to manage, I’d prefer to be in a local hospice. This would depend on them having availability at the time. The care I’ve witnessed in a hospice environment has been exceptional for those lucky enough to be admitted.
My final preference would be my local hospital and only if management of my symptoms requires admission. I have witnessed very good end of life care in my local hospital. However, the hospital environment (noisy, busy, lack of control and privacy) is the furthest away from my preferences. In terms of managing challenging medical symptoms though, a hospice or hospital definitely have the set up to provide this.
I do understand that the best place for me to die may be my local hospital if my circumstances include complex medical symptom control needs. However, if my symptoms are easily managed in my own home, that is where I would like to die. It would be great if as many of us as possible have done the research and written down our preferences. Conversations with our loved ones is an essential part of this process. When a decision needs to be made, these preparations mean that we are more likely to get as close as possible to our preferred place of care. More importantly, our preferences will be prioritised by those caring for us.