For the first time since the early 20th century, more Americans are dying at home than in hospitals, reported a research letter in The New England Journal of Medicine in December. The authors analyzed data for more than 35 million natural deaths in the U.S. from 2003 through 2017.
The percentage of people who died in a hospital fell from 40 percent in 2003 to 30 percent in 2017, while the percentage who died at home increased during the same period, from 24 percent to 31 percent. The proportion of deaths that occurred at nursing facilities also declined slightly (from 24 percent to 21 percent), while the proportion of deaths in hospice care rose (from 0.2 percent to more than 8 percent). People with cancer had the greatest odds of dying at home; stroke patients had the lowest.
The authors, from Duke University and the Veterans Affairs Boston Health Care System, noted that most people prefer to die at home but that family members can be unprepared for the enormous task of caring for a terminally ill person, often with little outside help.
“More information about the experience of patients dying at home is needed to develop policies and services that ensure high-quality end-of-life care,” they wrote. “These findings should lead to prioritizing improvements in access to high-quality home care for older Americans with serious illnesses.”
Also see End-of-Life Decisions.