Many people want to be at home

Around 56% of people in the UK say they would prefer to die at home. Among people who consider themselves to be in their last years of life, that figure falls to 42%, and around 20% would prefer a hospice (Marie Curie, 2024a). Preferences can also change as illness progresses.

However, the reality is more complicated.

Many people do spend most of their final months at home. The Better End of Life 2024 report, Time to care, found that in England, 64% of people spent most of their last three months of life in a private home, 24% in a care home and 7% in hospital (Marie Curie, 2024b).

Yet far fewer die there. Office for Health Improvement and Disparities (OHID) figures show that of deaths registered in England in 2024, 42.3% happened in a hospital, compared with 28.1% at home, 21.5% in care homes and 5.5% in hospices (OHID, 2026).

Hospitals remain the largest single place of death, although most people do not die there; the figures show a continuing gap between where many people would prefer to be and what the system is consistently able to provide.

This gap is not simply about personal preference. Reliable community services, access to medicines, clinical advice and enough support for family members all affect whether dying at home is achievable, safe and comfortable.

Home is about more than clinical care

Choosing palliative care at home does not mean managing without professional healthcare. Clinical care at home may involve GPs, district nurses, community nursing services, hospice teams and specialist palliative care professionals.

But home-based care is also about the human surroundings in which that clinical support takes place.

It may mean:

• remaining close to a partner, children, friends or beloved pets
• continuing familiar routines for as long as possible
• having privacy and time without unnecessary disruption
• choosing who visits and when
• enjoying favourite music, photographs, books or television programmes
• being supported to make everyday decisions
• having someone present when family members need to rest, work or leave the house

These details may appear small, but during a serious illness they can offer reassurance and continuity.

They help preserve the person’s identity beyond their diagnosis.

Families often carry much of the practical load. The same report found that 78% of unpaid carers/caregivers spent time “on call”, typically more than 50 hours a week (Marie Curie, 2024b). Alongside this, many are coordinating appointments, managing practical tasks and staying available through the day and night, and that is an exhausting responsibility, even when it’s undertaken with care.

The role of live-in care alongside NHS and palliative services

A live-in care professional can form one part of a wider plan for end of life care at home. At Noble Live-In Care, support is centred on the person’s daily life, preferences and sense of dignity.

A live-in care professional can provide:

• companionship and calm, consistent presence
• support with washing, dressing and personal routines
• help with meals, drinks and household tasks
• assistance with mobility and maintaining a safe environment
• support to attend appointments or remain connected with loved ones
• reassurance during difficult or unsettled periods
• regular communication with the family, where appropriate and agreed
• time for relatives to sleep, work, attend to other responsibilities or simply be present as family

Continuity matters.

When a team of care professionals gets to know a client’s habits, communication style, comforts and concerns, support can feel less fragmented. A familiar care professional may notice that someone is quieter than usual, is finding a routine difficult or would appreciate a particular family member being contacted.

However, this does not replace clinical care. Our care professionals are not registered nurses, doctors or allied health professionals. They do not provide nursing care, prescribe medication or manage medical symptoms. Clinical care remains the responsibility of NHS and specialist palliative care teams.

Care professionals do not administer clinical medication, adjust doses or make decisions about medicines. Where a client’s care plan includes support with routine, pre-prescribed medication, this is agreed in advance with the family and the clinical team and recorded in the care plan.

Care professionals will report changes to the family and, where agreed, to the relevant clinical team. They do not assess, monitor or manage clinical symptoms or deterioration. Sharing information with the family is subject to the client’s consent, and care professionals are bound by confidentiality.

What live-in care can do is help provide a settled home environment in which clinical services can be delivered. It can also help family members stay emotionally present, rather than carrying every practical responsibility themselves.

Honest conversations can protect choice

Planning for the end of life can feel daunting. Some families worry that talking about death will remove hope or cause distress. Others are unsure how to begin a conversation when the person they love does not want to discuss what may happen.

Starting the conversation

There is no single correct way to approach it. A conversation may begin with a gentle question:

• “What matters most to you if your health changes?”
• “Where would you feel safest and most comfortable?”
• “Who would you want involved in decisions?”
• “Are there things you would want to continue for as long as possible?”
• “What would you find especially difficult or frightening?”
• “Would you like us to talk with your GP or care team about your wishes?”

Planning ahead, and allowing for change

End of life care planning can include preferences about where someone would like to be cared for, who they would like involved, what brings comfort and how decisions should be made if they become unable to express themselves.

Wishes can change. A person may initially want to remain at home but later decide that a hospice offers the right environment for their needs. A flexible plan should make space for that. The purpose is not to create a promise that circumstances can never alter, instead, it’s to ensure that the person’s voice is heard and honoured.

Working with the clinical team

Where palliative care is being provided at home, families can ask healthcare professionals about advance care planning, shared care records, and medicines prescribed in advance and kept at home in case symptoms worsen (often called anticipatory or “just in case” medicines). These are prescribed and given by clinical teams, not by live-in care professionals. Families can also ask who to contact during evenings, nights and weekends.

Marie Curie reports that not every area has a 24/7 single point of access for palliative care advice (Marie Curie, 2024b). This can leave families relying on emergency services when they cannot reach advice or practical help.

Questions to ask before care begins

Before arranging care at home, it’s important to ask clearly:

• Who provides clinical support?
• Who should the family contact out of hours?
• What happens if symptoms change suddenly?
• Which professional is coordinating the care plan?
• What can the live-in care professional do, and what is outside their role?
• How will information be shared between the family, care provider and clinical teams?
• Is there a Lasting Power of Attorney for health and welfare, and if not, how would best-interests decisions be made under the Mental Capacity Act 2005? Families can discuss this with the clinical team and seek specialist advice on the legal instruments.
• Are there any ReSPECT or DNACPR forms the family should ask the clinical team about?

These questions are not signs of pessimism. They are part of caring responsibly.

For any out-of-hours situations, the plan should be clear. In a medical emergency, the care professional will call 999. For urgent advice, they will use NHS 111 or the out-of-hours contacts recorded in the care plan, and will inform the family and the relevant clinical team. They cannot give medication that is not provided for in the care plan.

What “24 hour care at home” means

Families often search for 24 hour care at home because they want reassurance that their loved one will not be alone. Live-in care provides a professional presence in the home, with support available throughout the day and night according to an agreed care plan.

It’s crucial to understand that live-in care is not the same as continuous active care or 24-hour nursing supervision.

A care professional needs appropriate rest and sleeping arrangements. Unless a waking-night arrangement has been specifically agreed, a live-in care professional is not expected to be awake and working throughout the night. Night-time needs that require clinical monitoring or intervention are met by clinical services, not by live-in care. Clinical emergencies must be handled by relevant NHS, urgent care or palliative care services.

A careful assessment should consider the person’s needs, the home environment, family involvement and the level of clinical support already available. Honest planning protects everyone: the person receiving care, their family and the care professional.

Scope and change of circumstances

Live-in care arrangements are reviewed as needs change. If someone’s clinical needs increase, for example if symptoms become difficult to control or a syringe driver is needed, the care plan will be reviewed. It may be necessary to involve additional clinical services, or to consider whether a different setting would better meet the person’s needs. Live-in care cannot be a substitute for clinical care, and we will always be honest with families about that.

Remaining in control until the end

Remaining in control until the end does not mean controlling every event. No family can predict precisely how an illness will progress, and no plan can remove every uncertainty.

It means being listened to. It means having choices explained clearly. It means receiving support that respects personal routines, relationships and beliefs. It means being able to change one’s mind without feeling that a decision has failed.

For families, it may mean having the strength to sit beside someone, hold their hand, share a favourite story or simply be quiet together. Practical support can ease the pressure on families, which may make those moments easier to find.

If you are considering end of life care at home, Noble Live-In Care can talk through the practical support that may be available.

We will explain what live-in care can and cannot provide, how a care professional can work alongside NHS and palliative care teams, and what information is needed to explore a safe and personalised care arrangement.

You can contact Noble Live-In Care to begin a conversation. You may also wish to read about our live-in care services and getting started with live-in care.

Because end of life deserves as much care and love as the beginning of life.

Remaining in control until the end should be supported with honesty, dignity, connection and compassion.

Where to get support

If you need support or guidance, you may wish to contact:

• your GP
• NHS 111 for urgent advice
• 999 in an emergency
• your local hospice
• Marie Curie’s support line

For current contact details, please use each organisation’s website.

Please note: This article provides general information about end of life care. It is not medical, clinical, legal or financial advice, and it is not a substitute for advice from a healthcare professional.

Noble Live-In Care does not provide clinical treatment or nursing care. Clinical care, symptom management and medical advice are provided by NHS services, GPs, district nurses, hospice teams and specialist palliative care professionals. If you are concerned about someone’s symptoms or immediate safety, call 999 in an emergency or NHS 111 for urgent advice.

References

• Butler, C. et al. (2022) Optimum models of hospice at home services for end-of-life care in England: a realist-informed mixed-methods evaluation. Health and Social Care Delivery Research. Southampton: NIHR Journals Library. Available at: https://www.ncbi.nlm.nih.gov/books/NBK583621/
• Marie Curie (2024a) Public attitudes to death, dying and bereavement in the UK re-visited: 2023 survey. London: Marie Curie. Available at: https://www.mariecurie.org.uk/public-attitudes-to-death-and-dying-report-2023
• Marie Curie (2024b) Time to care in England: Better End of Life 2024. London: Marie Curie. Available at: https://www.mariecurie.org.uk/document/time-to-care-in-england
• Office for Health Improvement and Disparities (2026) Palliative and end of life care factsheet: patterns of care, England 2024. London: OHID. Available at: https://fingertips.phe.org.uk/documents/peolc_patterns_of_care_factsheet_2024.html