England is now classified as an aged society with over 15% of the population aged 65 years and older. By 2035 it will be classified as super aged with more than 20% of the population aged 65 years and older. The past few decades have witnessed increased life expectancy for the population with the result that more people die at a much older age often following a period of increasing physical and/or mental frailty. In 1963, 9% of males and 18% of females died aged 85 years or older and in 2014, this was 30% and 48% respectively. The numbers of people dying and age at which they die will continue to increase significantly over the next two decades.
Care homes, both residential and nursing, play a critical role in the delivery of care towards the end of life for many, predominantly older, people. In 2005 16% (76,977) of people died in a care home but this has increased to 22% (101,203) in 2014. An even higher proportion will receive some of their care in care homes before death as approximately a third of people (28,892) living in care homes die elsewhere, mainly in hospital. There is significant variation by Clinical Commissioning Group across England in the proportion of people aged 75 years and older who die in care homes varying from 10% to 43%.
The causes of death of people who die in care homes also differ from those who die in other locations with 62% of people having some form of dementia mentioned on their death certificate compared with only 14% of those who die in hospital. A study of 2,444 deaths in care homes in southern England suggested that almost half of people who die in care homes do so after a period of slow dwindling decline and just over a quarter had a specific terminal condition.Care homes therefore provide end of life care to a significant proportion of the population who are also especially vulnerable.
This report is the first study at a national level of specialist palliative care support to care homes. It combines quantitative and qualitative approaches to give an extraordinary insight into the challenges faced by care homes and specialist palliative care services supporting them to provide high quality end of life care. It is also packed full of examples of good practice and truly moving quotes and vignettes illustrating the strong desire to provide good care at the end of life to people nearing the end of life in care homes. Importantly, this report adds another important piece of evidence to help drive forward the Ambitions for Palliative and End of Life Care: A national framework for local action, in particular the second ambition: each person gets fair access to care.
Public Health England commissioned this report with research carried out by the Marie Curie Palliative Care Research Centre at Cardiff University to better understand the nature and extent of specialist palliative care support provided to care homes. The steering group included representatives from NHS, The National Council for Palliative Care and Hospice UK together with PHE.