In 2017, the United States marked a historic shift unseen for over 50 years: more deaths from natural causes happened at home than in hospitals. Experts anticipate this trend will persist.
Researchers published a comprehensive study in the New England Journal of Medicine on December 12, 2019, analyzing 35.2 million natural-cause deaths in the US from 2003 to 2017. That year, 29.8% occurred in hospitals, while 30.7% took place at home.
Though the margin is narrow, it's the first time since the mid-20th century deaths at home have outnumbered those in medical facilities. The authors note a growing preference among Americans for passing away at home over institutions like hospitals or nursing homes. In contrast, France shows no such shift: INSEE data for 2018 reports 610,000 natural-cause deaths, with 53% in hospitals or similar settings and 24% at home.
Today, 45% of older Americans have advance directives instructing providers against life-prolonging measures. More are accessing home-based palliative care through Medicare, which saw a 4.5% rise from 2016 to 2017. Study leaders project continued growth.
Medicare's structure incentivizes hospitals with financial rewards for quicker discharges, even for terminally ill patients. This shifts care to families often unprepared for the demands. The study highlights the heavy burden on loved ones, who must be constantly available to manage symptoms like pain, breathing difficulties, and confusion.
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