For the first time in more than a half century, more people in the United States are dying at home than in hospitals, a remarkable turnabout in Americans’ view of a so-called “good death.”
In 2017, 29.8 percent of deaths by natural causes occurred in hospitals, and 30.7 percent at home, researchers reported Wednesday in the New England Journal of Medicine.
The gap may be small, but it had been narrowing for years, and the researchers believe dying at home will continue to become more common.
The last time Americans died at home at the current rate was the middle of the last century, according to Dr. Haider Warraich, a cardiologist at the Veterans Affairs Boston Healthcare System and a coauthor of the new research.
In Boston in 1912, about two-thirds of residents died at home, he said. By the 1950s, the majority of Americans died in hospitals, and by the 1970s, at least two-thirds did.
Americans have long said that they prefer to die at home, not in an institutional setting. Many are horrified by the prospect of expiring under florescent lights, hooked to ventilators, feeding tubes, and other devices that only prolong the inevitable.
Advocacy groups have encouraged families to have difficult conversations about end-of-life care, which often reveal that older relatives do not want heroic measures to extend their lives in hospitals.
About 45 percent of older people have completed advance directives, which often specify that doctors should not take extreme measures to prolong life.
And hospice care, usually delivered at home, is more available than ever before.
Some 1.49 million Medicare beneficiaries received hospice care in 2017, a 4.5 percent increase from 2016, according to the National Hospice and Palliative Care Organization.
“There has been a kind of cultural shift that has romanticized dying at home and made it the only way to die,” said Carol Levine, an ethicist at the United Hospital Fund in New York.
At the same time, hospitals have long had financial incentives not to keep Medicare patients for long periods, noted Dr. Diane Meier, a professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York.