If you gave people a choice – to die comfortably at home or in hospital – you would find that overwhelmingly, people would choose to be at “home”.

And yet many elderly people are dying in hospital emergency rooms – in a way that they may have not wanted to go.

Nowadays the definition of home is broader for many older people. For some it is the home they lived in with their family, but for many it is an aged care home that they may have been living in for months or even years.

People want to be comfortable when they die. Many don’t want to be scared and alone in a hospital cubicle, unsure of where they are and who they are with.

The reasons why this continues to be a problem comes down to a number of factors, but predominantly due to the lack of access to palliative care services and education for care workers – especially in aged care facilities.

What commonly happens is that as a person in their final stages of life deteriorates, an ambulance is called and the older person is taken to hospital.

This is often because many aged care staff are not equipped with the adequate assessment skills and confidence in their ability when caring for palliative care resident – they may not recognise that the resident is dying, or they do not know what to do in such circumstances.

Also General Practitioners and aged care facilities have not had the difficult discussions around the management of the older person in the event that they deteriorate, what will be the best place for them to be cared for and are there any further treatment options? If there are no medical treatments available then at what point do we decide to care for someone until they die in the facility rather than transfer to hospital.

“We get quite upset by that because coming to hospital and passing away in an emergency department is not by anybody’s definition a good death,” Dr Simon Judkins, Australasian College for Emergency Medicine president elect, Dr Simon Judkins, told The Age.

“My concern is for the family and the patient who has to spend their last hours in a busy, noisy, overcrowded environment.”

According to the Productivity Commission, each year, tens of thousands of people who are approaching the end of life are cared for and die in a place that does not reflect their choice or fully meet their end-of-life care needs.  

It was also reported that 70 per cent of Australians would prefer to die at home but few are able to do so. The number of people wishing to die at home with the support of a community-based palliative care service far exceeds the availability of that care.

The final stages of a person’s life can be very confronting if a person is unaware of how to handle it. It can include agitation, delirium, shortness of breath and restlessness.

Some of the most common signs that a person is dying is cold hands or feet that may begin to darken, a loss of appetite, confusion, problems or change in breathing and or unconsciousness.

A trained professional who knows how to manage those symptoms would immediately put in place comfort measures.

For palliative care to be incorporated more into aged care, there needs to be more palliative care training for the workforce.

Something as simple as recognising what a person is going through can be the difference between a “good” and “bad” death.

While some aged care facilities provide excellent care, the Productivity Commission reported that palliative and end-of-life care are poorly provided a number of aged care facilities.

The report highlighted an increase in people waiting on referral lists for palliatives care services. If aged care or community care nurses were provided with more education and training then the need for referrals to specialist palliative care services maybe alleviated to some extent. And thus, giving older people better access to palliative care before they die.

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