ABC of palliative care: The carers

In general, most of the final year of life is spent at home, although 90% of patients spend some time in hospital and about 55% of all deaths occur there. The burdens and rewards of caring for people in their last year of life are shared between informal carers (relatives and friends or neighbours) and healthcare professionals working in institutions or in the community. “The death of Theodore Gericault (1791-1824), with his friends Colonel Bro de Comeres and the painter” by Ary Scheffer (1795-1858). Until the start of this century, most people died at home while being cared for by family and friends About three quarters of people receive care at home from informal carers (residential or non-residential), most of whom are women. About a third of cancer patients receive care from one close relative only, while nearly half are cared for by two or three relatives, typically a spouse and an adult child. A smaller proportion of non-cancer patients than cancer patients have access to such informal care, reflecting their older age at death. Approximately two thirds of cancer patients and a third of non-cancer patients receive some kind of formal home nursing. District nurses are involved in the care of about half of cancer patients and a quarter of non-cancer patients. Palliative care nurse specialists, such as Macmillan nurses, are involved with about 40% of cancer patients but very few non-cancer patients. General practitioners see most patients at least five times during their last year of life, often at home. Healthcare professionals provide care on acute hospital wards and in outpatient clinics, and hospice inpatient staff care for about 17% of cancer patients during part of their terminal illness. Without the support of family and friends, it would be impossible for many patients to remain at home. It …