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Background: In rural settings, relationships between place and self are often stronger than for urban residents, so one may expect that rural people would view dying at home as a major feature of the ‘good death’. Aim: To explore the concept of the ‘good death’ articulated by rural patients with life-limiting illnesses, and their family caregivers. Design: Ethnography, utilising open-ended interviews, observations and field-notes. Participants: In total, 12 rural (town and farm) patients with life-limiting illnesses, 18 family caregivers and 6 clinicians, in the Snowy Monaro region of New South Wales, Australia, participated in this study over the course of the deaths of the patients. Interviews were transcribed and analysed with observational data using an emergent thematic process. Results: A ‘safe death’ was central to a ‘good death’ and was described as a death in which one could maintain (1) a connection with one’s previous identity; (2) autonomy and control over decisions regarding management of end-of-life care and (3) not being overwhelmed by the physical management of the dying process. For all participants, the preferred place of death was the ‘safe place’, regardless of its physical location. Conclusion: Safety, in this study, is related to a familiar place for death. A home death is not essential for and does not ensure a ‘good death’. We all have a responsibility to ensure all places for dying can deliver the ‘safe death’. Future research could explore the inter-relationships between safety and preference for home or home-like places of death. [ABSTRACT FROM AUTHOR]

Abstract: Residential aged care (RAC) is a significant provider of end‐of‐life care for people aged 65 years and older. Rural residents perceive themselves as different to their urban counterparts. Most studies describing place of death (PoD) in RAC are quantitative and reflect an urban voice. Using a mixed‐methods design, this paper examines the PoD of 80 RAC residents (15 short‐stay residents who died in RAC during respite or during an attempted step‐down transition from hospital to home, and 65 permanent residents), within the rural Snowy Monaro region, Australia, who died between 1 February 2015 and 31 May 2016. Death data were collected from local funeral directors, RAC facilities, one multi‐purpose heath service and obituary notices in the local media. The outcome variable was PoD: RAC, local hospital or out‐of‐region tertiary hospital. For the permanent RAC residents, the outcome of interest was dying in RAC or dying in hospital. Cross tabulations by PoD and key demographic data were performed. Pearson Chi squared tests and exact p‐values were used to determine if any of the independent variables were associated with PoD. Using an ethnographic approach, data were collected from 12 face‐to‐face, open‐ended interviews with four RAC residents, with a life expectancy of ≤6 months, and six family caregivers. Interviews were audio‐recorded, transcribed and analysed thematically. Fifty‐one (78.5%) of the permanent residents died in RAC; 21.5% died in hospital. Home was the initial preferred POD for most interviewed participants; most eventually accepted the transfer to RAC. Long‐term residents considered RAC to be their “home”—a familiar place, and an important part of their rural community. The participants did not consider a transfer to hospital to be necessary for end‐of‐life care. Further work is required to explore further the perspectives of rural RAC residents and their families, and if transfers to hospital are avoidable. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the place of death of residents in a rural region of New South Wales. Design: Cross‐sectional quantitative study using death data collected from local funeral directors (in person and websites), residential aged‐care facilities, one multipurpose heath service and obituary notices in the local media (newspapers/radio). Setting: Snowy Monaro region (New South Wales Australia). Participants: Residents, with advanced frailty or one of 10 conditions amenable to palliative care, who died between 1 February 2015 and 31 May 2016. Main outcome measure: Place of death. Results: Of 224 deaths in this period, 138 were considered amenable to palliative care. Twelve per cent of these deaths occurred in a private residence, 38% in the usual place of residence and 91% within the region. Conclusion: Most rural residents with conditions amenable to palliative care died in the region. Most did not die in their usual place of residence. Further qualitative work is needed to determine palliative care patients’ and family caregivers’ preferences for, and the importance placed on, place of death. While there may be a need to support an increase in home deaths, local rural hospitals and residential aged‐care facilities must not be overlooked as a substitute for inpatient hospices. [ABSTRACT FROM AUTHOR]