BLOG - How increased deaths at home during COVID-19 impacts the carer community

This week is Carers Week and our lead for Health and Social Care, Dr Iain Atherton, explores the implications of the pandemic for informal care and those who live alone, building on Dr David Henderson’s analysis from last week.

Death registration data provides invaluable insights into so many different aspects of death and dying. This is especially apparent during the current COVID-19 pandemic with daily updates on the numbers of people who have died who have had the virus.

Deaths at home are notable given the implications for informal carers, as well as for formal primary and social care. Dying at home often involves, indeed even requires, the intrinsic support and care of loved ones, often spouses, partners, and adult children. Those trends as to deaths at home tell us not only something about where people are dying, but raise questions about those providing care and support.

David’s blog clearly demonstrated a shift in the proportion of deaths occurring at home. The data he presented excluded COVID-19 deaths and hence cannot be explained by increasing numbers directly attributable to the pandemic. Rather, the figures point towards deaths that would have previously happened in hospital now happening at home. Indeed, figures from National Records for Scotland show that during the week of 18^th May 2020, more people died at home than died in hospital (NRS, last accessed on 10 June 2020). Whilst there has been some indication of a shift towards dying at home over recent years, and is the focus of work currently moving forward at SCADR, the figures represent a remarkable shift during the current pandemic.

There are likely a myriad of reasons as to why people might be increasingly dying at home. There may be a reluctance to admit people who are frail to hospital and especially where they are very likely approaching the end of life rather than needing acute treatment. There may also be an element of choice with people preferring to die at home during this period of time perhaps due to perceptions of the situation in hospitals.

Whether that shift towards dying at home is short or long-term is unclear. It may well be influenced by the duration of the ongoing pandemic. The production of a vaccine might shift approaches towards end of life care back to previous patterns of hospitalization, or it might be that this shift towards home deaths is longer term.

Either way, this shift gives focus on the role of informal carers and how we support their important role. Looking after a loved one at home during their final days is challenging both physically and psychologically. It also raises questions as to how to support those who perhaps do not have family immediately available to look after them.

In both scenarios, the importance of community services is crucial, to support those providing care to loved ones, and to ensure those with fewer options to draw on family or others close to them are supported.