Death at Home or in Community
A higher percentage is desirable.
The percentage of people who die outside the hospital each year
The numerator is the total number of deaths at home or in the community. This is calculated based on the difference between the total number of deaths in Canada and the total number of deaths in emergency departments and acute care hospitals. The denominator is the total number of deaths in Canada.
(All deaths in Canada [CVSD and Yukon death data] – Deaths in acute care hospitals and EDs [DAD/HMDB, OHMRS, NACRS]) ÷ All deaths in Canada (CVSD and Yukon death data)
Notes
CVSD: Canadian Vital Statistics Death Database.
ED: Emergency department.
DAD/HMDB: Discharge Abstract Database/Hospital Morbidity Database
OMHRS: Ontario Mental Health Reporting System.
NACRS: National Ambulatory Care Reporting System.
All deaths that occur in the calendar year (captured in CVSD and Yukon death data)
All deaths in the community in Canada in a calendar year
• Calculated by subtracting hospital and ED deaths from all deaths (CVSD/Yukon)
Methodology
Name
Death at Home or in Community
Short/Other Names
Percentage of People Who Die Outside of Hospitals Each Year
Description
Percentage of Canadians who die at home or in the community each year
“Home or community” is broadly defined as a location that a person resides in at the end of life, excluding hospitals and other acute care facilities. Locations include
- Long-term care facilities
- Hospices
- Nursing homes
- Residential homes
- Assisted-living facilities
- Group care homes
This definition is intended to include the many types of living situations that may be considered “home” at the end of life.
Rationale
Measuring the percentage of Canadians who die at home or in the community, rather than in hospital, provides an indication of whether Canadians are getting access to community-based end-of-life care services.
Many Canadians would prefer to receive end-of-life care at home rather than in hospital. One of the main barriers to dying at home is lack of support in the home. If more services in the home were available, more people could potentially be supported in dying at home. This indicator can monitor progress being made toward improving access to community-based end-of-life care services.
Interpretation
A higher percentage is desirable.
HSP Framework Dimension
Health system outputs: Access to comprehensive, high-quality health services
Areas of Need
End of Life
Targets/Benchmarks
N/A
Available Data Years
to (calendar years)
Geographic Coverage
- All provinces/territories
Reporting Level/Disaggregation
- National
- Province/Territory
Indicator Results
Web Tool:
Update Frequency
Every year
Latest Results Update Date
Updates
N/A
Description
The percentage of people who die outside the hospital each year
The numerator is the total number of deaths at home or in the community. This is calculated based on the difference between the total number of deaths in Canada and the total number of deaths in emergency departments and acute care hospitals. The denominator is the total number of deaths in Canada.
(All deaths in Canada [CVSD and Yukon death data] – Deaths in acute care hospitals and EDs [DAD/HMDB, OHMRS, NACRS]) ÷ All deaths in Canada (CVSD and Yukon death data)
Notes
CVSD: Canadian Vital Statistics Death Database.
ED: Emergency department.
DAD/HMDB: Discharge Abstract Database/Hospital Morbidity Database
OMHRS: Ontario Mental Health Reporting System.
NACRS: National Ambulatory Care Reporting System.
Type of Measurement
Percentage or proportion
Denominator
Description:
All deaths that occur in the calendar year (captured in CVSD and Yukon death data)
Inclusions:
All deaths in Canada in a calendar year:
- CVSD data
- Yukon death data
Exclusions:
- CVSD: Deaths from external causes:
- Land transport accidents (01–V89)
- Assaults (X85–Y09, Y87.1)
- Self-harm (X60–X84, Y87.0)
- Poisonings (X40–X49, X60–X69, Y10–Y19)
- Yukon: Category codes for assaults and self-harm
Numerator
Description:
All deaths in the community in Canada in a calendar year
• Calculated by subtracting hospital and ED deaths from all deaths (CVSD/Yukon)
Inclusions:
- Deaths captured in acute and psychiatric hospitals (DAD/HMDB/OMHRS)
- All deaths captured in NACRS, CVSD data and Yukon death data
- Emergency department records (Amcare_Group_Code = ED)
- Sex coded as male or female (Sex = M, F)
- Records with valid age
Exclusions:
- Deaths from external causes:
- Land transport accidents (01–V89)
- Assaults (X85–Y09, Y87.1)
- Self-harm (X60–X84, Y87.0)
- Suicide in facility (visit disposition = 74 in NACRS; discharge reason code = 2 in OMHRS)
- Poisonings (X40–X49, X60–X69, Y10–Y19)
- Dead on arrival (visit disposition = 71 in NACRS)
- Stillbirths and cadaveric donors
Method of Adjustment
Direct standardization
Adjustment Applied
Age-adjusted
Geographic Assignment
Place of residence
Data Sources
- DAD/HMDB
- NACRS
- OMHRS
- Vital Statistics - Death Database, Statistics Canada
- Vital Statistics Death Database, Yukon Government
Caveats and Limitations
Results are based on all available data reported to AV; data coverage differs across jurisdictions. Therefore, results should not be compared.
Some hospitals may have palliative care units that provide care similar to that offered community hospices, but these cannot be differentiated in the data. This may result in a higher number of in-hospital deaths for jurisdictions that have more dedicated inpatient palliative care.
Certain patients may prefer hospital-based care at the end of life. As well, in some regions (e.g., rural and remote areas of Canada), acute care hospitals may be the only care setting in which patients can access palliative or end-of-life care services.
Yukon Vital Statistics data is not currently submitted to the CVSD; therefore, categories in the Yukon Vital Statistics may be associated with errors. Additionally, death data may be incomplete. This indicator should be interpreted with caution for Yukon.
Trending Issues
N/A
References
Canadian Institute for Health Information. Access to Palliative Care in Canada. 2018.
How to cite:
Canadian Institute for Health Information. Death at Home or in Community . Accessed October 22, 2024.
If you would like AV information in a different format, visit our Accessibility page.
Comments
Pooled death data from 2017 to 2019 is used to age-standardize results.
This indicator belongs to the Shared Health Priorities portfolio measuring access to mental health and substance use services and to home and community care.
More information on this indicator is available in the 2022 companion report (PDF).