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Some issues to consider if older people with complex care needs choose to die at home

Peter Scourfield (Fellow at the Faculty of Health, Medicine and Social Care, Anglia Ruskin University, Cambridge, UK)

Working with Older People

ISSN: 1366-3666

Article publication date: 13 October 2023




This viewpoint paper focuses on the important role played by hospices in the UK in providing specialised end-of-life care for older people with complex needs – particularly for the growing number who choose to die at home. With demand for such care growing, the paper highlights the funding issues facing the independent hospice sector and the implications for hospices of receiving more state funding. The purpose of this paper is to highlight the challenges that hospices in the UK face in providing home-based palliative and end of life care for older people.


This a viewpoint paper informed by recent reports and research findings, as well as the author’s own work within the hospice sector.


The demand for specialised community-based and home-based palliative and end-of-life care is growing. The Covid-19 pandemic prompted wider discussion about what constitutes both “a good death” and good end-of-life care. This confirmed that most older people would prefer to end their lives free from pain, in familiar surroundings and not in hospital.

Practical implications

The specialised end-of-life care provided by hospices is rated highly by the regulator and the communities which they serve. In recent years, more attention has been given to providing “hospice at home” services, but coverage is limited largely due to lack of funding, the bulk of which comes from charitable fundraising. To provide a more equitable service, the fragility of the hospice funding model needs to be addressed.

Social implications

If the state expands its funding of hospice care, it is important that charitable fundraising also continues to take place and is encouraged. This will help ensure that the good links between hospices and local stakeholders are maintained.


The funding of the hospice sector in the UK has been the subject of several reports both by governmental and non-governmental bodies, several in the last year. However, it is an issue of growing importance and the whole subject needs a fuller airing in academic circles.



Scourfield, P. (2023), "Some issues to consider if older people with complex care needs choose to die at home", Working with Older People, Vol. ahead-of-print No. ahead-of-print.



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