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 A new analysis of death data, published in the New England Journal
of Medicine, found that dying at home surpassed dying in the
hospital beginning in 2017.
The last time more Americans died at home than at any other location
"would have to be in the first half of the 20th century," coauthor
Dr. Haider Warraich told Reuters Health. "At least since the 1970s
when we have reliable data, most people died in hospitals."
Men, whites and older patients were more likely to die at home, as
were people with cancer, the analysis found. People recovering from
a stroke had the lowest odds of dying at home.
"Patients with dementia had the greatest odds of death at a nursing
facility, and patients with respiratory disease had the greatest
odds of death at a hospital. Patients with stroke had the lowest
odds of death at home," the researchers report.
The trends, seen in people with all types of disease, have been
shifting for years.
From 2003 to 2017, the proportion of home deaths grew by 29% to the
point where they accounted for 30.7% of deaths.
Meanwhile, hospital deaths during the same period declined by 25%,
and hospitals were the place of death for 29.8% of Americans in
2017. Nursing facility deaths have also been on the decline, going
from 23.6% to 20.8%.
Although still accounting for a small share in the place-of-death
statistics, the biggest increase was in deaths in hospice
facilities. They were the locale for 0.2% of deaths in 2003 and 8.3%
in 2017, reflecting more than a 41-fold jump.
Hospice programs that let people die at home are a key reason
home-based deaths have become so common, said Warraich, who is
associate director of the Heart Failure Program in the Boston VA
Healthcare System.
"More people dying at home is good news," he told Reuters Health in
a telephone interview. "It aligns with what people want. If you ask
patients or loved ones where they would like to pass away,
regardless of where you are or how sick you are, home is the number
one choice. Being able to die at a familiar place becomes very
important for many patients, even if it's for a single day."
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The findings also suggest that the focus of the healthcare system
needs to be shifted away from end-of-life hospital care. "As home
becomes the place where most people die, this should catch the eye
of policymakers who should ask how we should be providing more
resources so people who want to die at home can do so," Warraich
said.
If hospice programs had better support and had the ability to offer
more services, he speculated, even more people would choose to die
at home.
The home death rate of 30.7% is still much lower than in Canada,
which has a rate of 59.9%, and England, where the rate is 46.0%.
The results are complicated by the fact that some of the death
certificates used in the study may have categorized assisted-living
facilities as home. Also, it wasn't always clear if hospice services
were provided at home or in a nursing facility.
The analysis by Warraich and coauthor Sarah Cross of the Duke
University Sanford School of Public Policy in Durham, North
Carolina, did not look at what was motivating more people to die at
home.
Financial issues, for example, "play a role in determining how
people choose to experience the end of life, but it's hard to know
from these data what's going on. We do know from other studies that
people with a higher socioeconomic status are more likely to die at
home in this country and other countries," Warraich said.
"Dying at home may not be doable for many people who don't have the
resources needed to be comfortable at home," he said.
For example, men - particularly married men - may be more likely to
die at home because they have more support there.
SOURCE: https://bit.ly/38vZz8W The New England Journal of Medicine,
online December 11, 2019.
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