Dying is a touchy subject, it’s true, but there’s one aspect of life’s end on which almost everyone seems to agree. When people are asked where they would prefer to end their lives, the number one answer is always the same: “at home.” Yet since the 1950s, people have been far more likely to pass away, not in the comfortable surroundings of home, but in the harsh, controlled environment of the hospital. However, that unpleasant reality may be slowly changing.
Dying at Home Has Outpaced Hospital Deaths for the First Time Since the 1950s
New research shows what the New York Times calls “a historic reversal” in the pattern of where most Americans die, according to this Times article we discovered a few weeks ago. “For the first time over a half century,” writes reporter Gina Kolata, “more people in the United States are dying at home than in hospitals.” This, the article reports, represents “a remarkable turnabout.” The difference is slight, but it marks an ongoing trend toward people passing away in their own homes. A research study recently published in the New England Journal of Medicine revealed that, in 2017, just under 30 percent of deaths by natural causes occurred in hospitals, compared with almost 31 percent at home. “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,” says the New York Times. (The article also shows just over 20 percent of seniors pass away in nursing homes, a figure which is slowly declining.)
One of the co-authors of the research study told the Times that the last time Americans died at home at the current rate was before 1950. The study looked at historical trends and found that in Boston in 1912, about two-thirds of residents died at home. But by the 1950s, the trend had shifted, and more Americans were passing away in hospitals than at home. This pattern peaked in the 1970s when at least two-thirds of natural deaths occurred in the hospital. But as the New York Times reports, this is exactly the opposite of what most say they would prefer. “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.”
The Number of People Dying at Home Represents a “Cultural Shift”
Part of the reason for this trend toward passing away at home may be because people have been encouraged to open up to their families about their personal preferences. “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,” says the Times article. “About 45 percent of older people have completed advance directives, which often specify that doctors should not take extreme measures to prolong life.” At the same time, the availability of hospice care is increasing nationwide: nearly 1.5 million Medicare beneficiaries took advantage of hospice care in 2017, a marked increase from the year before. As one medical ethicist told the New York Times, “There has been a kind of cultural shift that has romanticized dying at home and made it the only way to die.”
Dying at Home Puts a Burden on Families Who Are Often Unprepared
There may be plenty of positives in the new research on dying at home, but as the Times reports, there’s at least one significant concern. “Many terminally ill patients wind up in the care of family members who may be wholly unprepared for the task,” says the article. Dr. Sean Morrison, chair of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai in New York, told the Times that “We have put a tremendous burden on families in the type of care they have to provide and the type they have to pay for.” One woman cited in the article cared for her terminally ill husband at home for four long years. “It just went on and on and on,” she said. “The model of care wasn’t designed to give me any respite. It was absolutely exhausting.”
She told the New York Times, “There is a kind of fantasy where if you make all the right choices, you get this beautiful and peaceful death,” she added. “But you can do everything right and still have an unpredictable and tragic experience.” Many patients dying at home still need substantia care, and hospice may or may not be readily available. As one doctor put it, families often are “trapped by gaps in the system.” Family members tend to be the front-line caregivers and often have to figure out how to handle the burden on their own.
Planning and Open Communication are Essential in Preparing for the Future
Here at AgingOptions, we share this article not to cause dismay but to encourage you that the planning you do today can greatly increase the odds that your future will unfold as you hope it will. One way to do that is to communicate your wishes clearly and specifically to those closest to you. None of us wants to become a burden to those we love, but as Rajiv often says, good intentions aren’t enough. “As you get older,” he says, “the moment you fall ill, you’re going to become a burden to someone in your family. But you can plan ahead and make sure that, when that happens, your kids or your spouse know what you want and they know you’ve made the right preparations ahead of time.” A family conference, facilitated by AgingOptions at one of our offices, is a good place to start: give us a call and we’ll be glad to explain the process.
Planning for retirement means much more than how you choose to die. The important thing is how you choose to live! Rajiv has pioneered an approach to retirement planning that looks at all the vital aspects of retirement living – your money, your housing choices, your legal protection, your medical insurance, and your family dynamics – and weaves them together into a seamess plan called a LifePlan. With each element reinforcing the others, you’ll discover that you can create a retirement future filled with security and confidence. Let us introduce you to the LifePlanning process at a free seminar with Rajiv. These LifePlanning Seminars are held throughout the Puget Sound area, and there’s bound to be one convenient for you. Visit our Live Events page and sign up for the LifePlanning Seminar of your choice.
Do you have hopes and dreams concerning how you want to live in retirement? A LifePlan can help those dreams come true. Age on!
(originally reported at www.nytimes.com)