In January 2022, Marlene Viggers, a beloved matriarch, faced a terminal cancer diagnosis that left her with the heartbreaking choice of where to spend her final days. Her family rallied around her, ensuring she received loving, round-the-clock care at home with the invaluable support of Marie Curie, an end-of-life care charity. "She was in a lot of pain, but the comfort of being surrounded by family and familiar things eased her journey," recalled Neil Andrews, her son-in-law.

Marlene's situation is emblematic of a significant shift in end-of-life preferences in England and Wales, where a growing number of people are choosing to die at home rather than in hospitals. Recent data from the Office for National Statistics reveals that the proportion of deaths occurring at home increased by 5.3 percentage points from 2015 to 2024. Particularly during the Covid-19 pandemic, this trend surged; in 2019, 24.4% of deaths took place at home, while by 2022, that number had jumped to 28.7% and has remained above 28% since.

Sam Royston, from Marie Curie, noted, “Covid expedited a change that was already happening.” The pandemic forced people to confront mortality in unprecedented ways, with nearly 227,000 deaths attributed to Covid-19 in the UK from March 2020 until May 2023. Great emotional pain was inflicted during lockdowns, with many dying alone or saying farewell via hastily arranged video calls, as family members faced heartbreaking limitations in their ability to provide comfort.

Funerals were transformed, with large gatherings prohibited. This was poignantly highlighted by the solitary funeral of Queen Elizabeth’s husband in 2021, where the monarch was seen alone, a reminder that not even royalty was shielded from the pandemic's harsh realities. Such experiences have led many to reevaluate their views on death, health, and the meaning of a "good death."

A 2021 YouGov survey revealed that 25% of adults felt their perception of death had changed due to the pandemic, with many expressing heightened fears about losing loved ones. Moreover, an increasing number of individuals began to prioritize creating or updating their wills. Interest in alternative funeral ceremonies has since skyrocketed, with direct cremations—typically more straightforward and less costly—surging from just 3% of funerals in 2019 to an astonishing 20% in 2023.

Despite this shift, experts like Laura Davies from the University of Cambridge’s A Good Death project highlight a troubling trend: many still struggle to discuss their end-of-life wishes with family. While surveys indicate that nearly 56% of people prefer to die at home, over 43% of deaths, according to 2024 figures, still occur in hospitals. This discrepancy suggests a daunting gap between preference and reality.

The stark reality is that many individuals are not given the option to die in comfortable, familiar environments. Royston emphasized, “People want to spend their last days in places that respect their dignity and personal connections...and those environments are often found at home.”

Further complicating this are systemic issues within the healthcare system. A recent study indicated that a staggering 81% of the £11.7 billion allocated for end-of-life care in the UK was spent on hospital care—less than 20% on more intimate community, hospice, and primary care. This funding allocation points to a significant misalignment in resources, reflecting a need for improved community healthcare to enable more people to spend their final days at home.

Gillian Holtom faced personal challenges when her partner, Terry Leader, received a terminal diagnosis for stomach cancer. With the system overwhelmed during the pandemic, she struggled to access adequate support for home care. “I ended up Googling how to care for someone with terminal cancer... it was a miserable experience,” she recounted, reminiscing about the sorrow of watching her partner suffer without sufficient assistance.

As the pandemic exposed the fragility of the NHS, Davies noted that public confidence may drive the desire for home-based care. The accelerating aged population means demand for palliative care is projected to rise by 25% over the coming decades.

Neil Andrews, who cared for both his mother-in-law and mother at the end of their lives, encapsulated a universal truth about dignity in dying: “We all wish to pass on with dignity, with minimal pain, surrounded by love.” His poignant account, where a nurse opened the window to allow his mother’s spirit to leave her body, raised a compelling question: could such a moment even be replicated in the sterile environment of a hospital?

As society reflects on the changing landscape of death and end-of-life care, it bears witness to not only the pain but also the powerful compass of love, family, and dignity that guides individuals towards their final moments. Will the changes prompted by the pandemic lead to lasting shifts in our attitudes and systems surrounding death? Only time will tell.