By 2040, more people in England and Wales will die at home than in hospitals—yet no one has systematically asked whether a cramped, damp, or insecure rented flat can truly be a place for a dignified death. This matters because health policy and end-of-life care services currently treat “dying at home” as the gold standard for a good death, without interrogating what “home” actually means for people living in urban poverty. These households are more likely to face overcrowding, poor conditions, and precarious tenancies that make home-based care difficult or impossible. The research fills a critical gap: it examines how housing type and tenure shape the real experience of dying at home, from the perspectives of patients, families, and service providers. If successful, the study could reshape how the NHS, social care commissioners, and housing authorities plan end-of-life services. Instead of assuming home is always best, policymakers could tailor support—such as funding adaptations, temporary rehousing, or enhanced domiciliary care—to the actual conditions people live in. This could make end-of-life care more equitable, efficient, and humane for the growing number of people dying in deprived urban areas.
View original technical description
By 2040 home is expected to overtake hospitals to become the second most common setting for death in England and Wales (Bone et al, 2018). As the preferred place of death for most people and often used by service providers as a proxy for a ‘good death’, evidence on the impact of housing on dying at home and the provision of domiciliary end of life care services is limited. This is particularly the case for those living in urban poverty (Rowley et al, 2021) who are more likely to experience smaller homes, overcrowding, poor living conditions, and precarious rental tenancies. Despite this ‘home’ as a conceptual good at the end of life is rarely interrogated. It is critical to understand the significance of home and the impact of housing in order to arrive at meaningful, efficient and cost-effective delivery of end of life services, and it is ever more pressing for patients and their families given the relationship between housing conditions, health, and illness trajectories (Institute of Health Equity, 2020). There have been calls for more attention to be paid to the impact of housing on dying (for example Local Government Information Unit, 2012) including from a recent ESRC-funded study of social deprivation at the end of life in Scotland (see Quinn et al, 2023). In addressing this knowledge gap, this study will make distinctive interdisciplinary contributions to theory, policy, and practice from historical, social, clinical, and policy perspectives. Split across four internationally leading research centres, its objectives are to: Provide a detailed analysis of the history and evolution of policy on dying at home since the 1970s, to understand how the concept of ‘home’ is deployed in this policy narrative and why this outcome has come to dominate the end-of-life policy and practice landscape; Identify the meaning of ‘home’ and the role and impact of housing type and tenure on dying at home, from the perspective of patients and family members living in urban poverty and service providers; and Establish thorough stakeholder engagement throughout the conceptual, empirical and analytical phases, and make recommendations that recognise the distinct values attached to the concept of home and the impact of housing type and tenure on decisions made with regard to location of end-of-life care for people in urban poverty. We have four work packages to meet these objectives. Work package (WP) 1 is an archival analysis of policy on dying at home, exploring the values assigned to ‘home’ as a desired location at the end-of-life. Commencing six months later and taking place concurrently, WP2 and WP3 will examine dying and the provision of end-of-life services across housing types and tenure in two areas of urban poverty in England. Bringing together the policy analysis and empirical components of the project, the final work package will synthesise and analyse data thematically to make recommendations for policy and practice, identifying potential for improvements in home-based end of life care services, health and social care commissioning and the management of housing in areas of urban poverty. The study will thus present the opportunity to address critically the prevailing narrative that dying at home is a proxy for a ‘good death’ and the extent to which housing in areas of urban deprivation delivers a home in which people can die comfortably and with dignity.
Plain English summaries and category classifications on this site are generated by AI and may not perfectly reflect the original research.
Is something wrong? Let us know