Choosing where to die can be hard to think about. But whether you want to die at home, in a hospice, in a nursing home or in hospital, being in the right place for you can be really important. Your needs may change over time, but most people find it helpful to think about their choices before they become too ill.
Making your choice
It’s important for you to tell your healthcare team and the people closest to you if you have a preference for where you want to die. You may have different preferences depending on the situation. For example, you might choose to stay at home as long as you can, and then go into a hospice if it becomes too difficult to manage your symptoms.
Those caring for you will do their best to make sure you can die where you choose, but sometimes there are reasons why this isn’t possible. For example, if the person caring for you becomes unwell, or if you develop a new symptom that can’t be managed at home, you might need to change your original plan.
If you want to, you can record your preferences in an Advance Care Plan so that everyone involved in your care is aware of your choices. NHS Choices have some excellent advice on putting together an Advance Care Plan. And our ‘A better death’ guide also has useful information on the topic.
When do you have to decide?
Death and dying can be really hard to think about, so take the time you need and wait until you’re ready. If there is a chance your condition might suddenly change, your healthcare team might encourage you to make a decision. This can help them make sure they are carrying out your wishes.
After you have made your choices, it's still possible to change your mind. Let the healthcare team know and they will make sure that any Advance Care Plan is up-to-date with your wishes.
What are the options?
Your choices are likely to differ depending on where you live. The main places where a dying person can choose to die are:
There are no right or wrong decisions when it comes to making your choice. It’s about choosing where you feel most comfortable and considering what works best for you and the people who are important to you.
Many people feel that they would prefer to die at home, but you might have concerns about what it would be like. You may be worried about the impact on your family or those caring for you, or that it won’t be possible to control your pain. It’s important to speak to your healthcare team to understand what support would be available at home. This can often depend on where you live. It’s important for you to know that pain can be controlled for the great majority of people.
If you do choose to die at home, your healthcare team can organise any equipment and other items you may need. Being at home means you can be in familiar surroundings, and continue to get care from the people you already know.
You can be more flexible about things like mealtimes and eating what you want, and you can have any pets by your side. Sometimes carers also find this more convenient, as they’re able to have their own routine.
You may find it helpful to make some changes to your home, such as moving your bedroom downstairs. This can help you to feel more part of family life, and it may also have practical advantages. For example, it would stop you and your carer from having to climb the stairs, and would mean you are closer to the kitchen and other facilities.
Your healthcare team will make sure you get the medicines you need to control your symptoms. If your symptoms change or you become uncomfortable, you can call the district nurse or your GP who will be able to review your medication.
If you want to die at home, you may also be able to receive care from your local hospice, depending on where you live. This could include home visits from specialist nurses, visits to the day unit and short stays in the hospice. Finding this information out can help you and your carers, as it means you’ll know in advance who to contact for emotional or practical support.
Hospices provide specialist palliative care which can improve the quality of life for patients and families who are facing challenges associated with life-threatening illness. It’s a common myth that hospices are gloomy places. They’re calm and welcoming, with a friendly atmosphere and more homely surroundings than a hospital.
As part of your care, you may be referred to your local hospice as an outpatient for services such as complementary therapy or day therapy. You may also go into a hospice for a short stay - for example, while your healthcare team gets control of a new symptom or sees how you react to a new medication.
People sometimes choose to be in a hospice when they are concerned that their loved ones may not cope at home. People also choose hospices because they know that they will have access to specialist care 24 hours a day.
Going into this care setting can relieve many of the pressures on friends or family members who are looking after you. It could give you a chance to get back to your normal relationship with each other, rather than being patient and carer.
When you stay in a hospice, you can create a more personal environment by bringing your own belongings and perhaps having your pet to visit.
You can find out more about our hospices, or you can find the hospices nearest to you through the NHS. This type of care is usually provided free for the people who need it, through a combination of government funding and charity fundraising.
Around half of the people in the UK die in hospital. Most hospitals have palliative care teams who specialise in managing symptoms and looking after people with life-threatening illnesses.
It may not always be possible to choose to die on the ward where you have been receiving your treatment, however some cancer hospitals do have a palliative care ward. These special wards are often quieter than busy treatment wards and aim to provide an environment that’s more like home.
Nursing homes and residential homes are both types of care homes. They will have experienced care staff who can look after you. Although care homes usually offer long-stay care, you may also go into one for short-stay or respite care to support those caring for you.
If you want or need to go into a nursing home, the NHS may pay for it as part of your Continuing Healthcare, however many people will need to pay something towards their care. The exact amount you need to pay is worked out based on national guidelines.
I have elected to be treated in a hospice when my number is called. In the meantime, I have been attending a day hospice and got to know all the staff and other patients. It's just one day a week and we meet for a few hours and then have lunch - not a bad way to spend the day.
- a member of our Online Community talking about their wishes
Planning for the future
Deciding in advance where you want to die can be helpful for everyone. Although thinking about your death can be painful, having a plan in place can take away some of the stress and uncertainty for you and your loved ones.
You may also want to think about planning your funeral, writing a Will and giving someone the power to make decisions on your behalf if needed. You can find advice about this on our planning for the future support pages.
If your friend or relative is dying, you might find our Online Bereavement Community a useful space to talk to others who understand what you’re going through. You don’t need an account to read what people are saying, but you will need to sign up if you want to share your own experience of supporting someone who is dying.
As well as our Online Community, we also have lots of information about the grieving process on Grief Guide and our website. Plus, our Online Bereavement Counselling Service can help you start to process your feelings after they have died.