Care home residents – and death

This week in the BMJ, the excellent David Oliver collated some distressing data about hospital admissions and nursing and care home residents:

As background:

  • One in four nursing home residents die within a year of admission;
  • Median life expectancy is 15 months;

But I think the really big deal is around hospital admissions

  • Care home residents aged over 75 are three times more likely to have emergency admission compared to over 75s from the general population;
  • One in three residents admitted to hospital die during that admission

Oliver writes that “its often apparent when [nursing home residents] first arrive [in hospital] that they are close to the end of life … why not support them to die in the place they live?”

He says: “if it’s distressing for us [doctors] to witness, it’s much more so for [the old people themselves]”

I would like to add that deaths in care homes are rated highly. In the Voices survey, 82% of bereaved people whose relative or friend died in a care home rated overall care as outstanding, excellent or good, This compares to 83% in a hospice, 79% at home, and 69% in hospital. Care homes also rated well for dignity and respect offered to dying people.

So surely the onus must be on staff to ensure that deaths in residential and care homes are supported. That includes GPs and commissioners, as well as staff working inside homes.

Oliver cited Ashford and Walsall as specific places that are getting it right.

But why aren’t we getting it right everywhere?