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December 13, 2019

More people are dying at home than in hospitals. Is that a good thing?

Daily Briefing

    More people are dying at home than at the hospital for the first time in at least 50 years, according to a study published Thursday in the New England Journal of Medicine.

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    Study details

    The research, led by Haider Warraich, associate director of the heart failure program at the VA Boston Healthcare System, and Sarah Cross, from the Duke University Sanford School of Public Policy, was based on an analysis of federal death certificate data for natural deaths among U.S. adults that occurred between 2003 and 2017.

    According to the New York Times, hospitals for decades have been the most common place to die. In the 1950s, a majority of U.S. residents died in the hospitals, and in the 1970s, two-thirds died there, the Times reports.

    But the more recent data suggests there's been a shift in where U.S. adults are dying.

    A growing trend in end-of-life care

    The researchers found that from 2003 to 2017 the percentage of home deaths grew by 29% until they accounted for 30.7% of deaths among U.S. adults in 2017. In the same time period, hospital deaths declined by about 25%. In 2017, just 29.8% of deaths among U.S. adults occurred in hospitals, according to the study.

    Meanwhile, the study found nursing facility deaths declined from 23.6% to 20.8% of deaths among U.S. adults between 2003 and 2017. Hospice facilities, on the other hand, saw the biggest increase in deaths overall, the researchers found. Between 2003 and 2017, the proportion of deaths at hospice facilities increased from 0.2% of deaths to 8.3%.

    The researchers noted that a patient's age and condition was associated with where they died. Male patients were more likely to die at home than female patients, and young patients were significantly less likely to choose to die at home than older patients. Patients with cancer had the highest odds of dying at home, while stroke patients had the lowest odds of dying at home.

    Why more people are dying at home—and what that means for end-of-life care

    While the researchers did not determine what's motivating more people to choose to die at home, they believe people are choosing home deaths to increase their level of comfort and control.

    Warraich told Reuters, "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."

    That said, some health experts noted dying patients still need a substantial amount of care, which can make dying at home unpredictable and tough for caregivers to manage, the Times reports.

    Diane Meier, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, said, "I don't think families or caregivers understand what it's like to die at home." She added, "They will need to understand how to manage symptoms, like pain or shortness of breath or confusion. They are on-call 24/7 and have to be alert to changes at all times."

    Still, given patients' preference of dying at home, Warraich said the trend could indicate that the health care system should focus less on end-of-life hospital care and more on in-home hospice 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 (Edwards, NBC News, 12/11; Emery, Reuters, 12/11; Kolata, New York Times, 12/11).

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