Majority of Australians not dying the way they want to, Grattan Institute report finds, as care becomes more institutionalised

Updated

The majority of Australians are not dying the way they would like to, a new report says, with experts calling for greater public discussion around the benefits of palliative care.

The Grattan Institute's Dying Well report found 70 per cent of Australians want to die in their homes but only 14 per cent do, with half dying in hospital and a third in residential care.

Dr Hal Swerissen, who co-authored the report, said more Australians are dying from old age than they did 60 years ago and our healthcare system has failed to adapt to the change.

"There is increasingly people now dying in old age where 50, 60 years ago, more younger people died and you had a much greater emphasis on the healthcare system intervening at all possible cost," he said.

"When you are in your 80s or 90s and frail and you have a set of chronic diseases, it's difficult for the healthcare system to intervene successfully, so treatment is more difficult.

"We have got a healthcare system that is set up largely to do treatment and it is important that we have a moment in time where people can reflect on what they would like to have happen when it looks like there is not much benefit continuing with treatment.

"A good death is one where people have the opportunity to die with dignity and where they have control over the circumstances," he said.

The report found dying in Australia is more institutionalised than in most other countries.

It calls for more public discussion on the issue, as well as an expansion of community-based palliative care to give people the best chance of dying well.

"They (palliative care patients) get to choose where they die, with whom they die and how they die and to do that they then have the opportunity ... to say goodbye and to put their affairs in order and to make some sense of their own death and their own life," Dr Swerissen said.

Dying in hospital is expensive, expert says

Dr Rod MacLeod, a professor in palliative care at the University of Sydney and a senior staff specialist at Hammond Care, said the best way to enable a good death is to provide "care in the home in the last few days of life".

"The program that we are doing with New South Wales Health allows for up to 48 hours of care," Dr MacLeod said.

"It can be all in one lot or it can be interspersed over days or even weeks and that seems to enable people, most of the time, to stay where they want to stay."

The report said doubling the number of people who die at home will cost $237 million a year, but the same amount of institutional care funds could be released to pay for it.

Dr MacLeod said overall a great deal of money would be saved if more people died at home.

"Dying in hospital is expensive," he said.

"If you think of all the infrastructure and the interventions that happen, there's a lot of interventions, there's a lot of medications, a lot of staff involved whereas if you're dying at home, the medications can be kept to a minimum, the staff are kept to a minimum."

Topics: community-and-society, death, health, academic-research, australia

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