‘The beauty and the less beautiful’: exploring the meanings of dying at ‘home’ among community and practitioner representatives and advocates across Canada

Abstract

Background: Significant structural and normative pressures privilege the ideal of dying at home in Canada. At the same time, the social complexities and meanings associated with dying in particular locations remain critically unexamined. Objective: The aim of this study is to explore how diverse community members, including health and social care stakeholders, talk about preferences for locations of dying, with a particular focus on meanings of dying at home. Design: Semi-structured virtual interviews were conducted with 24 community and practitioner representatives and advocates across Canada during the Covid-19 pandemic. This included compassionate community advocates, palliative care professionals and volunteers, bereaved carers, and members of queer, rural, and immigrant communities. Participants were asked about their own preferences for location of dying and elaborated on these aspects with regard to their client population or community group. Results: Our analysis illuminates how meanings of dying at home are connected to previous experiences and perceptions of institutional care. As such, participants’ perspectives are often framed as a rejection of institutional care. Dying at home also often signals potential for preserving ontological security and relational connection in the face of life-threatening illness. However, participants’ expertise simultaneously informs a sense that dying at home is often unattainable. At times, this awareness underpins interpretations of both preferences and choices as contingent on considerations of the nature and type of illness, concerns about impacts on families, and available resources. Conclusion: The ideal of dying at home is nuanced by identity, relational, and structural contexts. Knowledge from this study can inform realistic and practical person-centered planning across care settings. It can also help create more representative public policy and health system quality indicators regarding a ‘good death’ that do not rely on or perpetuate undeveloped and unrealistic assumptions about dying, home, and family care.

Matters of care and the good death – rhetoric or reality?

“…For example, social imaginaries often include home as an indicator of the ‘good death’. This does not account for how political as well as social and cultural factors influence where people are cared for and die 13,14▪ . The ‘good death’ as ‘home death’ script problematises the value of dying somewhere other than home.…”

Naturalizing dying at home for older adults: A critical analysis of policy texts

“…As part of a larger mixed methods project studying preferences for and meanings of dying at home in Canada (Chan et al, 2023; Funk et al, 2022; Funk et al, 2023), we identified public policy related to dying at home (including both palliative and end‐of‐life care) within written documentation in which the federal and provincial/territorial governments state public directives for the health care system. This included 12 policies or formal statements, 19 websites, 15 action/strategic plans, and 13 bilateral health agreements (Table 1).…”