Hospice, Care Home or Home: Choosing Where to Be Cared For at the End of Life (UK)

In short: end of life care can be given at home, in a care home, in a hospice or in hospital. There is no single right choice. It depends on the person's wishes, how complex their symptoms are, and how much help is available around them. Hospice care and NHS healthcare are free. Care home fees and care workers at home may have to be paid for, unless the NHS or council pays.

Start with what matters most

Everyone has the right to say where they would like to be cared for and where they would like to die. Hospice UK and Marie Curie suggest thinking about priorities such as:

• being free from pain and discomfort;
• being with family and friends;
• being in familiar surroundings;
• having privacy;
• having access to specialist care.

The care team should try to support the person's wishes, but it isn't always possible to give the care someone needs in the place they would like. Needs can change, and people can change their minds. That's fine.

Care at home

Many people would like to stay at home. The GP has overall responsibility for someone's care at home and can arrange for community or district nurses to visit. Specialist palliative care nurses can also visit to advise on pain and symptoms and support the family.

• Hospice care at home: some hospices send their teams to people's homes. Marie Curie Nurses provide free care at home, including overnight care in some areas.
• Personal care: the council's social services can arrange help with washing, dressing and meals, plus equipment and adaptations. Care workers visit at set times and won't be there all the time. Marie Curie says the maximum is often four visits a day.
• Family carers: think honestly about how much family can do, especially as needs grow. Carers can ask the council for a free carer's assessment.

Our guide to home care explains how care at home works.

Hospice care

Hospices care for people with an illness that cannot be cured. They look after physical, emotional, social, practical and spiritual needs, and support the family too, including after the death. Most offer medical and nursing care, including managing pain and other symptoms.

• It isn't only for the last days. Hospice care can start at any point after a terminal diagnosis. Some people stay for a short time, for example 10 to 14 days, to get symptoms under control, then go home.
• It isn't only a building. Hospices also offer day services, outpatient appointments and care at home.
• It is free. Hospice care is paid for by a mix of NHS funding and donations. Hospice UK says more than £1.3 billion of the £1.8 billion hospices need each year comes from donors.
• Places are limited. A GP, hospital doctor or district nurse usually makes the referral. Some hospices accept self-referrals.

Hospice UK says there are more than 200 hospices in the UK, caring for about 310,000 people a year. Many hospices have a room where relatives can rest or stay overnight.

Care in a care home

Care homes have trained staff to look after people day and night, with help such as washing, dressing and meals. Homes with registered nurses are often called nursing homes. They suit people with a serious long-term condition or very limited mobility. Hospice UK says care homes suit people who can no longer manage living on their own. A local hospice team, the GP and district nurses may also be involved.

The NHS suggests asking a care home:

• What does the Care Quality Commission (CQC) say about it?
• Do staff have regular end of life care training?
• How do the GP and community nurses support residents, routinely and in emergencies?
• Is the home accredited for end of life care, for example by the Gold Standards Framework?

Care homes usually welcome visits, but they don't usually have rooms for relatives to stay overnight. Palliative and end of life care in a care home covers this in more detail, and you can search nursing homes near you.

Hospital

Hospital may be the best place if someone needs specialist treatment. Many hospitals have specialist palliative care teams. They can also help plan a move home, or to a hospice or care home. Hospital wards are busy, and there is often little privacy for relatives who want to stay for long periods.

Who pays?

• Hospice: free.
• Healthcare at home: care from the GP, district nurses and hospice teams is free. Marie Curie Nurses are free.
• Personal care at home: the council assesses needs and finances. You may pay some or all of the cost.
• Care home: the council may pay all or part if the person qualifies. If the home costs more than the council will pay, the family may pay the difference. If the person isn't eligible for continuing healthcare but needs nursing, the NHS pays a contribution towards nursing care.

Our guide to NHS continuing healthcare explains when the NHS pays in full.

Plan ahead and write it down

The NHS suggests talking to family and the care team early, and writing wishes down as an advance care plan. A ReSPECT form can record wishes about emergency care and treatment. A lasting power of attorney lets someone you trust make decisions if you can't.

Related guides

• Fast-Track NHS Continuing Healthcare: Free NHS Care at the End of Life
• End of Life Care at Home: Arranging Support in the UK

Sources

• What end of life care involves (NHS)
• Deciding where you have end of life care (NHS)
• End of life care at home (NHS)
• End of life care in a care home (NHS)
• Hospice care (NHS)
• End of life care in hospital (NHS)
• Why plan ahead for end of life care? (NHS)
• Choosing where to be cared for (Hospice UK)
• What is hospice care? (Hospice UK)
• What we do (Hospice UK)
• Choosing where to die (Marie Curie)
• Hospice care (Marie Curie)
• What is end of life care? (Marie Curie)