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What can we do to help Australians die the way they want to?

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A different service mix could better meet end-of-life care needs for little additional cost

Australians are not dying as they would wish. Surveys consistently show that between 60% and 70% of Australians would prefer to die at home, and that residential care facilities are their least preferred option.1

Dignity, control and privacy are important for a good death. Choice over who will be present, where people will die and what services they will get, matters. People want their symptoms to be well managed, and they want personal, social and psychological support. It is important to have the opportunity to say goodbye and leave when it is time to go without pointlessly prolonging life.2

But dying is now highly institutionalised. Over the past century, the proportion of deaths at home has declined and that of deaths in hospitals and residential aged care has increased. Today only about 14% of people die at home in Australia. Fifty-four per cent die in hospitals and 32% in residential care. Home and other non-institutional deaths are about half as prevalent in Australia as they are in New Zealand, the United States, Ireland and France.3

Paradoxically, the likelihood and timing of death is now more predictable and there is more opportunity and time to prepare for death because people are now much more…