Location of care and death in the last days of life

In advance, discuss preferences for the location of care and death with the patient, family and carer(s). Many, but not all patients, would prefer to die at home, but this may need to be reviewed as death draws closer because the patient’s care preferences or needs may change. Additional factors that influence this decision include the physical and emotional wellbeing of the carer(s), the complexity of medical management required, and the availability of resources to maintain adequate supervision and care at home.

Moving a patient from home to inpatient care (eg hospital, palliative care unit) may be required if carers become exhausted or the patient’s needs cannot be met at home; it is important to reassure patients, family, carers and staff that this should not be seen as a failure.

If a patient is in hospital and prefers to die at home, if possible, arrange discharge and community services.

Planning ahead can help avoid death during transit or in an emergency department. If the patient is not in their preferred place of care or death when nearing the last days of life, discuss their preferences and the benefits and risks of transfer; organise timely transfer (if appropriate).