Deaths at home soar to all-time high during pandemic – but increase driven by dementia and heart disease

Expert warns sustained mass move to home care would require healthcare system to adapt its focus

The coronavirus pandemic has seen a vast rise in the number of people dying at home (Christopher Furlong/Getty Images)

People are continuing to die in their homes in record numbers after deaths outside of healthcare settings hit an all-time high during the pandemic – but Covid appears not to be responsible.

There was a 29 per cent rise in deaths in private homes in 2020, amounting to 166,576 fatalities, the Office for National Statistics (ONS) confirmed on Wednesday.

This is more than at any point since records began in England and Wales two decades ago in 2001, when fewer than 100,000 people died at home.

The findings have prompted warnings that the healthcare system may need to adapt its focus if continually vast numbers of people are choosing to receive care or spend their final days outside of healthcare settings, which would represent “a significant shift in demand”.

However, provisional new findings that there were 85,910 home deaths in the first six months of this year suggest home deaths remain at record levels but may be slowing slightly – with 84,051 recorded during the same period in 2020, the first few months of which were less impacted by the virus.

Rather than Covid-19 itself causing the vast rise, the ONS reported “substantial increases” in people dying from other causes, such as heart disease, cancer, dementia and Alzheimer’s.

The pandemic appears to have had an “indirect effect” and more investigation is needed to understand why, said Sarah Caul, head of mortality analysis at the ONS.

“This could be because of a combination of factors which may include health service disruption, people choosing to stay away from healthcare settings or terminally ill people staying at home rather than being admitted to other settings for end-of-life care,” Ms Caul said.

Ischaemic heart disease was the main leading cause of death in private homes between January 2020 and June 2021, with 27,048 male deaths registered – 18 per cent above the pre-pandemic average – and 12,183 female deaths, 10 per cent above average.

Deaths where dementia and Alzheimer’s disease was the leading cause during this period were 72 per cent above average for men and 62 per cent above average for women – the largest percentage increase among causes.

Deaths where lung cancer was the leading cause of death were also above average, by 21 per cent for men and 35 per cent for women.

Private homes are the only setting where deaths have been consistently above the pre-pandemic average every month from January 2020 to June 2021. Even in recent months, when nearly all lockdown restrictions have been eased in England and Wales, there are still many more people dying at home than usual.

There were 75,474 “excess deaths” – those exceeding the previous five-year average – in private homes registered between 7 March 2020 and 29 October 2021, just 12 per cent of which are reported to have involved coronavirus.

More than 10,000 of these deaths have occurred since the start of August. This compares with about 5,000 excess deaths in hospitals and 1,400 in care homes over the same period.

The figures may reflect “worries about catching Covid-19 and increased demand for health services” but said the direct links “are not yet clear” and further research is needed, said Sarah Scobie, deputy director of research at the Nuffield Trust health think tank.

“If this trend is set to stay and more people are choosing to die or be cared for at home, then it represents a significant shift in demand for healthcare, and more focus will be needed to ensure families, patients and carers at home have the right support,” she said.

It comes less than a fortnight after Marie Curie warned that people are dying at home without the correct nursing support or pain relief because of staff shortages.

The end-of-life charity surveyed nearly 550 nurses across acute and community settings, more than half of whom said they felt the standard of care had deteriorated during the pandemic.

Julie Pearce, the charity’s chief nurse, warned of “a hidden crisis happening behind closed doors and people dying without access to pain relief or the dignity they deserve” and urged MPs to support an amendment to the Health and Care Bill to “create a legal duty to commission palliative care services in every part of England”.

Additional reporting by PA