Did you know that although two-thirds of elderly people would prefer to die at home, nearly the same number, 58 per cent, end up spending their final days in hospital? It will surprise few that hospital is about the most undignified and impersonal place for anyone to end their days – not to mention dangerous. I've seen a number of very elderly people die in hospital. It can be a pretty dispiriting experience for the patient as well as their families and friends, even in hospitals where the care is good. One lively elderly friend who was admitted to a London hospital with mild bronchitis three weeks after her 100th birthday, died three weeks later as a direct result of a ward infection caused by poor hygeine. She died alone – unknown by any of the hospital staff – with no personal effects around her, or loved ones to provide cheer. There is much to be said for the comforting and holistic experience of being at home with the support of friends and/or family. It is almost exactly three years since my own 88 year old father, a family doctor of five decades, died in the local cottage hospital after truly dreadful, often disrespectful treatment at the hands of a nearby district hospital (the cottage hospital with only a handful of beds is one that he and his colleagues had fought to save when the NHS threatened to close it down). The staff at the cottage hospital could not have been kinder nor more helpful and sensitive, but for a man whose home and garden meant everything to him, it was an indifferent, cold and unsympathetic end to a life as a family doctor serving the community. So why do people end up in hospital against their wishes? The problem is that there are insufficient nurses available round the clock to give people the support they need to have a comfortable death at home — such as administering pain-relieving drugs and providing advice on how to make the person most comfortable in their final days and hours. As a result of the NHS financial crisis, many district nurses were made redundant two years ago and numbers have still not recovered. This shortage means that people often end up in hospital, knowing that they are very unlikely to see their home again. And in many cases, even if an elderly person has made it plain where it is that they want to die, the information is not shared with the rest of the NHS. The government admitted yesterday that employing more district nurses to provide end of life cover would not necessarily cost the NHS more, but could actually save around £104m if the number of people admitted as emergency cases was cut by ten per cent, and if the average length of hospital stay was reduced by three days. We can only hope that this week's report will translate into positive action as soon as possible.
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