Objectives: To identify the distribution, evolution and the determinants of the places of death in the Canton of Geneva during the past three decades; To formulate the objectives of a social and health care policy based on the needs and the rights of dying people in relation to the places of death.
Methods: Analysis of the mortality database of the Swiss federal office of statistics and the reports of the Geneva cantonal statistics office.
Results: Between 1970-2000, the proportion of deaths at home decreased by 20% passing from 27.6% in 1970 to 19.7% in 2000;-the same trend is seen in hospital based deaths. Their ratio was modified from 72.6% in 1970 to 50.7% in 2000;-the proportion of the deaths occurring in nursing homes was multiplied by 6, passing from 4.5% in 1970 to 26.2% at the end of period- Age, sex, educational level and the social class are the most powerful predictors of dying at home.
Discussion: Over the studied period significant changes occured in regard to places of death in Geneva,-Data shows a progressive transfer of deaths from home settings to hospitals and from hospitals to nursing homes without any formal training program in palliative care for nursing homes workers;-Social inequalities are present in regard to dying place which limits the accessibility to the palliative care for female, and deprived people. It seems of prime importance to develop health and social policies which (a) give access to the palliative care services for all (b) favor training programs in palliative care the nursing homes (c) support the development of palliative care services at the end of life.