1. Palliative Care in New Zealand: Strategic Challenges
University of Canterbury
July 2018

2. Place of Death

3. Place of Death in New Zealand 2000-2013
33.9% of all deaths occur in a public hospital, with 31.4% in residential care. Note that the figure of 6.2% is for hospice inpatient unit deaths only, not all hospice involvement. 22.3% of all deaths occur in a private residence.
Data Source: Ministry of Health MORT data

4. Place of Death in New Zealand 2000-2013
Over the period there has been a proportional decline in deaths in public hospital and other settings, with a substantial increase in the proportion of deaths in residential care.
Data Source: Ministry of Health MORT data

5. Place of Death in New Zealand 2000-2013
There are strong patterns by age and gender. Deaths in public hospital are highest under 1 year old and decline at the oldest ages. There is an expanding “funnel” of deaths in residential care at older ages.
Data Source: Ministry of Health MORT data

6. Place of Death in New Zealand All Ages, 2000-2013
Considering all ages, proportionately more men die in private residence or other settings. Proportionately more women die in residential care, at 38.1% of all deaths.
Data Source: Ministry of Health MORT data

7. Place of Death in New Zealand Age 65 and over, 2000-2013
For deaths at age 65 and over, 44.7% of women and 31.2% of men die in residential care. The predominant place of death for men is public hospital at 36.4% of deaths.
Data Source: Ministry of Health MORT data

8. Place of Death in New Zealand Age 85 and over, 2000-2013
For deaths at age 85 and over, 59.2% of women and 47.6% of men die in residential care. Public hospital as a place of death is proportionately higher for men than for women at these ages.
Data Source: Ministry of Health MORT data

9. Place of Death in New Zealand Male Deaths, 2000-2015
Residential care has become an important place of death over the period, surpassing private residence in 2011 and almost reaching the level of deaths in public hospital in 2015.
Data Source: Ministry of Health MORT data , extracted March 2018

10. Place of Death in New Zealand Female Deaths, 2000-2015
Since 2001, residential care has been the most likely place of death for New Zealand women. The gap between residential care and public hospital continues to widen.
Data Source: Ministry of Health MORT data , extracted March 2018

11. Place of Death in New Zealand Neoplasms, 2000-2015
Residential care has become an increasingly important setting for deaths from cancer, overtaking public hospitals in 2010 and overtaking residential care for the first time in 2015.
Data Source: Ministry of Health MORT data , extracted March 2018

12. Comment
The trend to increased numbers of deaths in residential care has continued strongly with the addition of another two years of data.
Residential care has long been the most likely place of death for New Zealand women, but is now also the most likely place of death for those with cancer. It is very close to becoming the most likely place of death for men (across all ages and causes of death).
This underscores the importance of including palliative care in the contracts with aged residential care.
Standards of care across all settings should be harmonised.
It is essential to implement and monitor common outcomes measures across all settings of care.

13. Heather McLeod & Associates Ltd
Body, Mind, Soul
Earth
Heather McLeod
Heather McLeod & Associates Ltd
Honorary Senior Research Fellow, School of Nursing, University of Auckland
Extraordinary Professor, Department of Statistics and Actuarial Science, University of Stellenbosch