With More Americans Dying at Home, Providers Must Double Down on End-of-Life Care

The home has become the place where most Americans die of natural causes — beating out hospitals for the first time since the early 20th century.

The trend sheds further light on the need for in-home care, including palliative care services and even proactive, non-medical home care. This is one takeaway from a study published Thursday in the New England Journal of Medicine.

In some ways, the fact that more Americans are dying at home could be seen as a success for all types of in-home care, Theresa Forster, vice president of hospice policy at the National Association for Home Care & Hospice (NAHC), told Home Health Care News. Ultimately, if more people are dying at home, that means health care is improving upon keeping individuals out of acute settings.


“The study’s findings indicate a symbolic and very real victory in that we believe [the findings] translate to more individuals having their desire to die in a familiar environment, among family and friends, fulfilled,” Forster said. “At the same time, we believe that even greater inroads can be made in this area, particularly through increased use of advance care planning and palliative care prior to hospice eligibility.”

As part of the study, researchers from the Sanford School of Public Policy at Duke University and Harvard Medical School examined data from the U.S. Centers for Disease Control and Prevention and the National Center for Health Statistics from 2003 through 2017.

Overall, 29.8% of deaths stemming from natural causes took place in hospitals — and 30.7% occurred at home in 2017.


In addition to the success of in-home care providers, the findings also fall in line with the widespread preference for remaining in one’s home for care services and the popularity of aging in place among older adults.

Researchers discovered that patients with cancer had the best odds of dying at home or at a hospice facility. Meanwhile, patients with dementia are more likely to die at a nursing facility, and patients with respiratory disease are more likely to die at a hospital.

Broadly, the study’s findings, according to researchers, may mean that there are additional opportunities for in-home care providers that specialize in dementia care to reach an untapped market of older adults that are currently being served in nursing facilities.

“One thing that has occurred in our business is our average number of hours per client, per week is skyrocketing. Dementia is what’s driving this,” Felton Magee, president and CEO of Regent Healthcare, said at the Senior Care 360 conference in August.

Founded in 2008, Regent Healthcare is one of the largest, non-franchised home care agencies in Maryland. The company operates throughout more than a dozen Maryland counties and provides care on a private-pay basis.

Additionally, the study’s findings also make a case for increased accessibility when it comes to palliative care, according to Edo Banach, president and CEO of the National Hospice and Palliative Care Organization (NHPCO).

“More Americans dying at home is reflective of where people want to be cared for, and what they and their families experience when cared for in an institutional setting,” Banach told HHCN. “With more Americans wanting to be at home, we need to clearly define community-based palliative care benefits that outlines exactly what services are available.”

In general, older adults who need palliative care don’t always receive it. About 60% of people who would benefit from palliative care in the U.S. don’t receive it, according to another report from the New England Journal.

Of 425 palliative care programs surveyed in 2018, only 7% were home health, according to statistics from the National Palliative Care Registry.

The Duke and Harvard researchers note that the study’s findings should lead to improvements in access to high-quality home care for older adults with serious illnesses.

“The trends noted here represent progress; however, more information about the experience of patients dying at home is needed to develop policies and services that ensure high-quality end-of-life care,” the researchers wrote.

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