Dying at home: a prospective comparative study of home death rates in a private health insured palliative care community programme

Abstract

Background: Despite preferring end-of-life care at home, only a small percentage of deaths in Australia occur in private homes. Aim: This study evaluates a private health insurance-funded support programme (provided in addition to the standard level of community palliative care), the rates of home death, the percentage of patients who died in their preferred location and the satisfaction with the care provided. Methods: This prospective study enrolled patients in two cohorts: the Medibank cohort (with private health insurance, a prognosis of less than 3 months, a preference for home death) and the standard cohort (publicly funded patients, with no limitation to prognosis or preferred place of death). Demographics and preferences for place of death were collected. Results: The first 12 months of the study are reported here with 132 patients (Medibank cohort, n = 67; standard cohort, n = 65). Medibank patients that died had significantly shorter contact with the service compared with the standard cohort (median 13.5 days vs 39 days), a higher home death rate (79% vs 44%) and a higher rate of preference for a home death (97% vs 59%). The proportion of deaths in the patients' preferred location was similar for both groups. Conclusion: The high home death rate observed in the Medibank cohort highlights the potential benefit of enhanced palliative care support at the end of life. This support should be dedicated, accessible and resourced with in-home nursing assistance and allied health interventions.