For the first time since the early 1900s, more americans are dying at home rather than in hospitals, a trend that reflects a growing adherence to palliative care and the kind of end-of-life experience that most people say they want.
Nursing home deaths have also declined, according to report in this week's issue of the New England Journal of Medicine.
"It's a good thing," he said. Dr. Haider Warraich, cardiologist at the Veterans Affairs Boston Healthcare System and senior author of the study. "Death became overly medicalized in the last century," and this shows a departure from this, he added.
Warraich and student at Duke University Sarah Cross used government health statistics on deaths from natural causes between 2003 and 2017. During this period, the proportion that occurred in hospitals dropped from 40% to 30% and the number of nursing homes fell from 24% to 21%.
Meanwhile, household deaths increased from 24% to 31%. Some assisted living centers may have been counted as homes; the researchers had no way of telling.
People who were younger, women, or a racial or ethnic minority were less likely to die at home than older people, men or whites, the researchers found. Cancer patients were more likely to die at home, but people with dementia and lung disease were more likely to die in a hospital.
Betsy McNair, a guide who lives in Mexico, said she was proud of the ending she helped give her father. Robert McNair was 83 when he died at home in Belle Haven, Virginia, in 2009, six weeks after learning that he had lung cancer.
“I made him exactly what he wanted to eat whenever he wanted to. He drank whiskey every night, had a very high quality of life. If he woke up at two in the morning and wanted coffee and pie, that's what we did, "she said.
The type of disease is important, McNair said. In addition to her father, she helped care for a brother who died of Lou Gehrig's disease in his 50s and his mother, who died at 92 in a nursing home after a long decline in health.
"It was completely different experiences," and sometimes you can't take proper care of a family member at home, McNair said.
Allison Beach and her husband struggled to figure out how to get help for their mother, Kathryne Beach, who lived with them for three years before dying at her home in Hinesburg, Virginia, in 2016. She had lost her sight, had a fall, and then succumbed to heart failure at age 91.
“We had to really reshape our lives. I was determined not to put her in a facility, ”said Beach, who is a nurse. "We were alone with her at the time of death and I wish I had more support."
The experience led Beach to seek special end-of-life training, hoping to help others in these circumstances.
The increase in home hospice services has helped more people spend their last days at home, Warraich said.
"I've met a lot of patients who just want to spend a day at home, around the dog, in bed, able to eat food at home," he said.
Not only are people living longer, but they usually spend more years at the end of their life with chronic diseases.
"Ideally, we would like to see people live longer and with fewer disabilities," he said. "We have work to do there."