Aging-in-Place at the End-of-Life in Community and Residential Care Contexts

Population aging is a global phenomenon that has presented capacity and resource challenges for providing supportive care environments for older people in later life (Bone et al., 2018, Finucane et al., 2019). Aging-in-place was introduced as a policy driver for creating supportive environmental and social care to enable individuals to live independently at home and in the community for as long as possible. Recently, there has been a move towards offering care for people with a terminal illness at home and in the community (Shepperd et al., 2016); and when appropriate, to die in supportive, home-like environments such as care homes (Wada et al., 2020). Aging-in-place principles can, thus and, should be extended to enabling supportive, home-like environments at the end-of-life. Yet, first, we must consider the appropriateness, availability and diversity of options for community-based palliative and end-of-life care (PEoLC), in order to optimise supports for older people who are dying at home or within long-term/residential care environments. Globally, across places with similar health and social care systems and service models such as in Scotland and in Canada, community-based PEoLC options are currently not uniformly available. Given that people entering into long-term/residential care homes are increasingly closer to the end of life, there is now an even greater demand for PEoLC provision in residential facilities (Kinley et al., 2017). Although most reported deaths occur within an inpatient hospital setting (50%), the proportion of overall deaths in a care home setting is projected to increase from 18% to 22.5% (Finucane et al, 2019). This suggests that long-term/residential care homes are to become the most common place of death by 2040, evidencing the need to develop and sustain appropriate and compassionate PEoLC to support those who are able to die at home and those living in residential care facilities (Bone et al., 2018; Finucane et al., 2019). This research initiative is premised on the notion that aging in place matters throughout the life-course, including at the end-of-life and that the socio-environmental aspects of care homes need to enable this.