End of life care at home: what it involves and who pays

Quick summary

Most people say they would prefer to die at home, and far fewer do. Money and speed are usually the reasons, and both can be sorted faster than families realise. Fast Track NHS Continuing Healthcare funds the whole package, is not means-tested, and the national framework expects care to be in place within 48 hours.

The gap between wishes and what happens

Marie Curie’s research has consistently found that a substantial majority of people would choose to die at home, while a much smaller proportion actually do, with hospital remaining the most common place of death. Home deaths rose after 2020 and the gap has not closed.

It is rarely because families do not want it. It is because nobody explained the funding, or because the care could not be arranged quickly enough, and an admission happened instead.

Fast Track funding

Where someone has a rapidly deteriorating condition and may be entering a terminal phase, a clinician can complete a Fast Track Pathway Tool for NHS Continuing Healthcare.

• It funds 100 per cent of the care package, at home, in a hospice or in a care home.
• It is not means-tested. Savings, income and the house are irrelevant.
• The national framework expects care to be commissioned within 48 hours of the completed tool reaching the Integrated Care Board.
• It can be completed by an appropriate clinician, including a GP, hospital consultant, specialist nurse or hospice doctor.

Ask for it by name. Marie Curie’s own research into delivery found significant variation in how quickly Fast Track packages were actually delivered, and some people unfortunately died waiting. Families who know the words get a faster answer than families who ask generally about funding.

Our guide to Continuing Healthcare covers the standard route, which is slower and works differently.

Who does what

End of life care at home is not one service. It is several, and knowing who does what saves a lot of ringing round.

A home care provider does not give injections or manage syringe drivers. Those are nursing tasks, and the care plan should be clear about the boundary.

What to put in place early

The families who manage best at home have usually sorted these before they were urgently needed.

• The Fast Track application. First, because it unlocks everything else.
• Anticipatory medicines in the house, sometimes called just in case medicines, prescribed by the GP so that district nurses can act quickly at night.
• An out of hours plan, including who to ring at 3am and a record that the person wishes to be at home.
• Equipment. A profiling bed, pressure-relieving mattress, commode. District nurses or occupational therapy arrange these, usually quickly at this stage.
• A discussion about resuscitation and preferences, recorded where out of hours services can see it.
• Night cover. The most common reason a home plan fails is exhaustion, not medicine.
• A key safe, so nobody is left outside at night.

What home care actually provides

• Personal care, washing, changing, mouth care and keeping someone comfortable and dignified.
• Help with eating and drinking, for as long as that is wanted, and accepting when it is not.
• Sitting services, so somebody is there and the family can sleep.
• Overnight and live-in support.
• Company for the person, and someone to notice changes and call the district nurse.
• Practical support for the household, which nobody else picks up.

The part families value most is usually the least clinical: not being alone with it at two in the morning.

Being honest about home

Home is right for many people and it is not right for everyone.

A hospice bed may give better symptom control where pain or breathlessness is difficult. Some people find home frightening once they are very unwell. Some houses cannot accommodate a bed downstairs, and some families cannot sustain it, which is not a failure.

Support for the family

• A carer’s assessment from the council, in your own right.
• Hospice family support and bereavement services, which often begin before the death and continue afterwards.
• Marie Curie’s support line and information services.
• Your own GP. Ask to be recorded as a carer.
• Practical help, which our guidance for families and the carers’ support piece cover in more detail.

Frequently asked questions

Who pays for end of life care at home?

Where Fast Track Continuing Healthcare applies, the NHS funds the whole package and it is not means-tested. Outside that, care is arranged through the council after a financial assessment, or privately.

How quickly can it be arranged?

The national framework expects a Fast Track package within 48 hours of the application reaching the Integrated Care Board. Delivery varies, so ask for progress daily and escalate if nothing moves.

Who completes the Fast Track form?

An appropriate clinician: GP, consultant, specialist nurse or hospice doctor. Ask directly whether a Fast Track application is appropriate.

What if we are turned down?

Ask for the reasons, and ask the GP or specialist nurse to review whether the criteria are met. A care needs assessment from the council should run alongside in any case.

Does Fast Track funding stop if they live longer than expected?

Fast Track awards are reviewed, and some people remain on them for a considerable time. A review is not the same as withdrawal.

Can carers give pain relief?

Home care workers can support medicines in line with the care plan and their training. Injectable medicines and syringe drivers are nursing tasks handled by district nurses.

About Visiting Angels Cheshire East

Visiting Angels Cheshire East provides care at home across Macclesfield, Wilmslow, Knutsford, Congleton, Alsager and the surrounding villages of East Cheshire, along with Buxton, Whaley Bridge and the Staffordshire Moorlands towns.

• Overnight, sitting and live-in support, so families are not awake every night.
• No visit is ever shorter than an hour.
• You see the same faces, which matters a great deal at this stage. Our carer turnover is 12 per cent, against a sector figure of 23.7 per cent (Skills for Care, 2025).
• We work alongside district nurses and the hospice, not instead of them.
• Care can often start within a few days, and faster where Fast Track funding is in place.

David’s mother in law is supported at home:

“Visiting angels have been a massive help in the care for my mother in law, who is getting increasingly confused. They provide companionship and support every day proving to be very reliable and consistent. They are there at times we can’t be, due to all the commitments of work and grand children.”

David Figg, Google review

Talking it through

There is no assessment fee and no obligation. If someone wants to be at home and you are trying to work out whether it is possible, we can talk through what would be needed, what the NHS should be funding, and what we would cover.

Call us on 01625 720157. You can also send an enquiry, and you can see what our services cover.

Authored by Dr Haroon Ahmad, Managing Director, Visiting Angels Cheshire East.

Published 27 September 2026. Last updated 27 September 2026.

This article is general information about end of life care and funding, not medical, financial or legal advice. Decisions about treatment, symptom control and eligibility rest with the clinical team and the Integrated Care Board. The author is a director of the company and is not acting in a clinical capacity, and Visiting Angels Cheshire East provides personal care at home rather than medical or nursing care. National framework guidance and local services change; check the current position. Support is available from Marie Curie, your local hospice and Cruse Bereavement Support. To the fullest extent permitted by law, GB Care at Home Ltd accepts no liability for any loss arising from reliance on this article.