The End of Life Care strategy promotes choice of place of care and of death for all patients, yet research continues to show more people die in hospital than anywhere else, despite home being the place of choice for the majority. (ONS 2014). Individuals who have no partner or family support, and are over 75 have almost no chance of achieving this goal (Gao et al., 2013).
A one-year pilot project, funded by St. James’s Place Foundation planned, recruited, and trained volunteers with a health care background to be companions to lone patients who wanted to die at home. They offered sessions of around four hours duration to patients referred by primary care teams and who fulfilled agreed criteria. Volunteers were mainly available during evenings and at weekends, when most services are at their least well-staffed. They offered a calm, reassuring and supportive presence to the patient and any family present.
Achieving choice of place of death for this specific patient group and deflecting inappropriate admissions were initial objectives. However, poor uptake resulted in wider geographic location, and extension of the service to patients in community hospitals and the hospice, and earlier, additional support, including to families.
Focus on this specific patient group is recommended as a national strategic objective, to offer equity in end of life care choices (NEoLCIN 2014). This is a complex issue, involving willingness to advance care plan, changing priorities as health deteriorates, and the human element of loneliness. More people, of a greater age, will live in single-person households in the future, and are likely to die alone. (housinglin.org.uk, 2012). Is this a service that is before its time? Statistics show that patients in areas of greater deprivation are less likely to die at home – thus should such a service be located by demographic need?
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