Where does an elderly or terminally ill person want to die? Depending on the private and medical situation, there are various possible places: at home, in a hospice, in a retirement or nursing home or in hospital. Each place has its own peculiarities in terms of the people who surround you, the rules – and of course the costs. The atmosphere, the possibility of involving relatives and, last but not least, the way in which the dying person is treated differ.
The inpatient hospice
First of all: what is a hospice? An inpatient hospice is an independent facility, both structurally, organizationally and economically. Each hospice has its own trained staff and its own concept. However, the aim is always to provide each patient with the best possible psychological, (palliative) nursing and (palliative) medical care in a harmonious environment at the end of their life.
This nursing care in a hospice is provided by trained full-time and volunteer nursing staff. Medical care is provided by doctors experienced in palliative medicine. Social workers, psychologists and chaplains take care of the psychological and pastoral needs of patients and relatives – often on a voluntary basis.
In addition to hospices for adults, there are also children’s hospices in some countries (such as Germany and Austria). However, because the range of services on offer usually barely meets the demand, interested patients and relatives have to expect waiting times in many places.
Dying at home
Many palliative patients prefer to die at home in familiar surroundings. Outpatient/mobile services can often make this possible.
In Germany, for example, outpatient nursing and hospice services are available and – for patients in more complex situations – palliative care teams (PCT). Corresponding care structures in Austria include mobile nursing and care services, mobile palliative care teams and hospice teams. In Switzerland, external hospital care services and mobile palliative care services can enable seriously ill or dying patients to spend the last phase of their lives in their own home.
End-of-life caregivers also have an open ear for the patient’s relatives – even after the death, for example when it comes to grieving or organizing the funeral. Hospice services/hospice teams are also there for relatives.
You can read more about the various care structures for palliative patients here.
Dying in a care home
It is not possible to make a general statement about the competence and quality of hospice care in retirement and nursing homes. This is because every home has a different concept, a different philosophy and also different staffing and spatial capacities.
In many homes, however, the staffing ratio is low – there are too few staff for the patients. This often leaves too little time to meet the requirements and needs of a dying person. There is also usually less involvement and support for relatives than in a hospice, on a palliative care ward in hospital or through outpatient (mobile) hospice services or hospice teams.
However, outpatient/mobile hospice services or hospice teams can also accompany patients in nursing homes in their final phase of life on request – as can volunteer end-of-life companions.
Dying in hospital
Doctors and nursing staff trained in palliative medicine work there – supported by representatives of other professional groups such as psychologists and social workers. Chaplains and volunteers are also involved in the care of seriously ill and dying patients. They should receive comprehensive care in all areas – medical, nursing and psychosocial – in line with their needs.
Knowing that they can receive appropriate care at any time relieves the fear of pain, shortness of breath or other unbearable symptoms for many patients and makes their last days a little easier. Relatives also benefit from the professional round-the-clock care: they can relinquish responsibility and withdraw from time to time to recharge their batteries for themselves and the dying person.
Nevertheless, the hospital remains a hospital: the environment is unfamiliar, the staff changes more frequently, a certain routine sets in among the doctors and nursing staff, and it is difficult to ensure sufficient privacy.
