Surely you remember movies from childhood and maybe a bit later showing the patriarch of the story dying in his bed as family members hover around?
I sure do. It was such a common scene back then that images of several different ones are stored in my head still, although I can't name the films.
For eons, dying at home was the norm. And then, beginning in the early 1900s, it wasn't anymore.
Now, for the first time since then, more people in the U.S. are dying at home than in hospitals and nursing homes. As CNN reported in December:
”The researchers looked at the number of natural deaths in the United States based on data collected by the US Centers for Disease Control and Prevention and the National Center for Health Statistics.
“They define natural deaths as when a medical condition leads directly to death, meaning people died from heart problems or cancer, among other diseases, rather than dying in a car accident, for example. The authors looked at data from 2003 to 2017.
“They found that hospital deaths are still common, but that number is declining. There were 905,874 hospital deaths in 2003, 39.7% of deaths. And by 2017 there were 764,424 hospital deaths, 29.8% of deaths.”
As veteran science and medicine journalist, Gina Kolata, reported in The New York Times,
”In Boston in 1912, about two-thirds of residents died at home, [Dr. Haider J. Warraich, a cardiologist at the Veterans Affairs Boston Healthcare System and a co-author of the new research] 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 fluorescent lights, hooked to ventilators, feeding tubes and other devices that only prolong the inevitable.”
But it is not always easy to die at home. Dr. Warraich, writing recently in the Washington Post, notes how difficult it can be for both family caregivers and the dying person.
”...as more people die at home, it also means that much more responsibility falls on the shoulders of patients and their caregivers. Caregiver burden is a growing problem in America. As a doctor tending patients with heart failure, I am keenly aware of how hard managing care can be for both patients and family members.”
He says, too, that many people feel strongly about where at home they want to die, and there are other practical and personal considerations:
“Nearness to a bathroom is key. Sometimes, light remodeling, such as installing handrails in bathrooms or ramps, is helpful.
“A person at the end of life will probably have feelings about who they want to spend time with — or who they don’t want — so it is important to discuss in advance who will provide caregiving, along with who might provide occasional backup for regular caregivers.”
According to the study, there has also been an increase in the number of people who die in hospice facilities.
”In hospice,” explains CNN, “an interdisciplinary team of professionals that specialize in end-of life-care address the whole person. They work to help manage pain and the person's physical needs, as well as their mental and spiritual distress. Hospice also helps the family and coordinates care.”
Medicare (and other insurance) covers hospice care which often takes place at home. Last year, an internet friend had been under home hospice care but was grateful in the last few days of her life to move to a hospice house where she could receive additional care allowing her the time to let go.
A home hospice worker can't do everything the patient and family need and there are other options. Kelly Sanders, who is an RN and end-of-life doula in Michigan, told Healthline,
“'Hospice does a great job taking care of the medical aspect of dying, but due to the changing nature of healthcare compensation, little time was left for the other aspects of dying that are just as important for a peaceful passing,' she said. 'End-of-life doula services fit that need.'
“She said there is a big misconception that hospice provides the same services as a death doula.
“...a death doula can fill a gap in care. People can work with a death doula before they reach a point where they qualify for hospice. And an end-of-life doula is able to devote themselves to a single person, going in without an agenda to fulfill that person’s needs.”
When I started pulling this story together, I intended to give you these new statistics about where people die, and let you know how people – medical professionals, families, those who are dying – deal with the choices. But there's a lot more to it than I had considered for one short blog post.
So. Let's stop here for now and over the next while I will post additional information about such issues as advance directives, hospice at home and at a facility, doulas, etc. that we can discuss individually.
Today, I'm curious about how much thought you have given to where and how you want to die. Do you think it is morbid to talk about? (Most old people don't.) Have you talked with your family about end-of-life issues? And so on.
(I urge you to follow the links within the story above. They have a great deal more good information.)