There are several choices for end-of-life care. This page outlines these options and lists some of the benefits to consider.
Choosing where to die is a personal decision. The options covered here all have pros and cons.
You’ll need to evaluate your physical needs and the support that can be provided by family and friends. In some cases, you may feel like your choice is limited, and that the practicalities help decide the setting. This may be because you have medical needs that only a hospital, hospice or palliative care unit can meet, or you may live in an area too remote for home visits. Your house may be unsuitable, perhaps because of stairs or a small bathroom.
Discuss with your family or friends where you’d like to have end-of-life care and what is important to you. Ask them about their views and preferences.
You may be concerned about dying with dignity. This means different things to different people, but for many it means dying with respect for your wishes and the way you want to die. For help working out the best option for you and your family, talk to the palliative care team.
As you approach the end of life, you may wonder how you will know the end is near. Where people would like to die may change over time and as their circumstances change.
People often talk about wanting to have a ‘good death’. What this means is unique for everyone, shaped by his or her attitudes, cultural and spiritual backgrounds, as well as medical treatments.
Although there is no right way to die, research has identified some common factors that can help a death seem good, including:
With planning, you can achieve a good death. Dying at home may be seen as a marker of a good death, but there is more than one way to die well. The important thing is that you are able to decide and have your physical and emotional symptoms well controlled.
Achieving a dignified and peaceful death can help family cope better with bereavement.
If asked, many people say they want to die at home around familiar surroundings and people. While it may not be the option everyone might choose, if you do want to be at home, then help and support may be available for you and your carers. Even if you live alone, with planning, you can stay as long as possible in your own home.
|Who can help you stay at home?|
|Your GP||overall responsibility for your care|
|Palliative care team||helps you and your family maintain quality of life|
|Community-based nurse||provides ongoing care|
|Volunteer||provide a range of support services – can help with home or personal care|
|Physiotherapist||helps make the physical aspects of your life easier|
|Social workers||Organise help with housework, shopping and cooking or personal care|
|Occupational therapist||assesses your home and suggests equipment, such as hospital beds, wheelchairs and bedside commodes|
|Counsellor, psychologist or psychiatrist||helps you work through your feelings|
|Pastoral care worker||talks about any spiritual matters|
It’s a good idea to check how your family and friends feel about home care. Some carers may appreciate having you nearby and not having to fit in with the hospital routines. Other carers may be frightened and worried that they don’t know what to do. Although dying is a natural process, few people have experience or knowledge of looking after someone who is dying. If you find your family isn’t supportive of you staying at home, talk to your doctor, nurse or palliative care team. They can advise your family of what assistance is available, and reassure them that they don’t have to cope alone.
Although you may wish to die at home, you may change your mind as you get closer to the end of life. Sometimes people go into a hospice or hospital to have their symptoms managed or to give their carers a break, and then return home. Talk to your palliative care team about ways of dealing with unplanned events. Have the contact details of professionals you can call if you need advice and support.
For more information on how they can cope, suggest your carers read caring for someone nearing the end of life.
You may decide that you’d be more comfortable in a setting with staff who have the expertise to help your family and friends look after you.
A hospice focuses on end-of-life care centred on quality of life. Staff specialise in providing physical and emotional comfort to the patient, and supporting the family before and after the death.
Hospices are different from hospitals. They are often quieter and calmer, and have a more homely environment. You can stay for a short period of time, and sometimes you can go back and forth during your final weeks. Many hospices now have a maximum length of stay, so you may want to check this when booking in.
Hospices are valued for their relaxed surroundings, skilled staff and symptom management. The hospice may offer a break from mainstream health care and respite from people wanting to visit you. You may choose this option if you want to relieve your family from caring for you while dying, although they can still be involved. They can help in many ways, such as feeding, bathing and offering comfort by reading, sharing music, or simply being present.
Some people and their family and friends are unsure of when to contact a hospice. They may wait to call the hospice until the final days, possibly missing out on the support that this environment has to offer. Talk to your palliative care team or doctor about when it’s a suitable time to call the hospice.
More people approaching the end of life die in hospital than anywhere else. While some people 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, and they know you and understand your specific needs. You’ll need to check if this is possible as sometimes people are moved to a different ward as their medical needs change.
To help create a more homely environment, ask if you or your carers can bring in familiar items from home, such as a favourite blanket or photos.
Hospitals can provide medical interventions, such as resuscitation and intravenous lines, that some people may think are unnecessary as a person nears death. If you are concerned, talk to the hospital staff. You can request that you don’t receive them.
The quality of end-of-life care in a hospital can be managed with communication and advance care directives. Preparing an advance care directive can help give you control over the type of medical treatment and interventions you receive. See further details on what this is and how it can help ensure your wishes are followed.
"The hospital staff took care to ensure we had a private space to gather as a family, and we could come and go to my husband’s bedside."
A nursing or residential home is a place where people stay who need continual care and help with daily living. They are available to people who have different conditions, and nurses and aides are available 24-hours to provide care.
Some people fear that dying in a residential home will be unpleasant and perhaps frightening. Yet dying in a nursing home can be comforting, particularly if it has been your home for a period of time and you are familiar with the staff, who will try to create the right environment to make you comfortable.
If an illness is prolonged or very debilitating, some people think about speeding things up. Euthanasia is when somebody’s life is deliberately ended to relieve them of their suffering from an incurable condition or illness.
Voluntary euthanasia is illegal in every state in Australia. Nevertheless, it is something that some people consider when they are seriously ill.
Sometimes a person with cancer may decide that they want their death hastened, but later decide that they don’t. They may have thought that way because they were feeling particularly ill, scared, or worried about the strain they were putting on others.
If this is how you feel, discuss your concerns with your doctor, a counsellor or social worker. Sometimes these feelings are due to depression, feeling helpless or because pain is not being well controlled.
Pain and depression can almost always be treated, and help is generally available for other symptoms. It is important that you talk to your doctor or nurse about any physical or emotional symptoms that are causing you pain or distress, and find ways to make your final days more comfortable.
If you urgently need somebody to talk to because you are thinking about ending your life, call Lifeline on 13 11 14 for free, confidential telephone counselling at any time of the day or night.