Everyone should have the option to die at home

Have you given any thought to where you want to spend your final days? The recent National Palliative Care Week encouraged us to consider, in depth, our own end-of-life care, and discuss it with our loved ones.

When people are asked about end-of-life, they commonly express a preference for care at home. This is where they feel safe and comfortable, and surrounded by the familiar.

Dying at home isn't an option for everyone, nor is it everyone's preference.

However, if you do want to stay at home, and there's no compelling reason why you need to be in hospital, shouldn't you be able to choose that? Although Australian palliative care rates fairly well internationally, rural people are less likely to have the choice to stay home, due to difficulties with accessing care.

Fewer GPs visit rural people at home and palliative care services can be geographically distant, also lacking the funding to cover all the need.

This is where district nursing comes in. These nurses, who travel throughout regional areas, reduce the burden of travel for healthcare and treatment. They enable rural people to live longer at home.

District nurses often become involved in the lives of the people they care for, so that they get to know them well and understand their individual needs.

They can also be great advocates for choice, by providing access, information and support that empowers people to achieve their end-of-life goals.

Through talking to people like Janet - an elderly woman who had struggled hard to return to her home in a small rural town after suffering a stroke - I know that their services are critical for many rural Australians.

The problem is that district nurses work alone, and limited resources, emotional stress and ethical dilemmas affect their ability to advocate for their patients.

Like many frontline workers, district nurses are often only called when the situation at home has reached crisis point and is difficult to manage.

Their strong commitment to care also often takes them beyond the call of duty, volunteering extra time and energy to help keep people at home.

As a community, let's better support district nurses. If they can visit early when a terminal illness is first diagnosed, and feel supported to better care for people who are terminally ill, more rural people can achieve their end-of-life goals.

Dr Fran Reed is a researcher in rural health at La Trobe University