Most Americans would prefer to die at home. Surveys show that 90% of our population wants to pass away in their own beds.
There was a time when the majority of deaths were homebased. In 1912, two-thirds of those passing succumbed there.
“Throughout human history, and until very recently, most people died at home,” Dr. Mark Williams, an expert on aging, writes. “In many cases in western culture, it was an occasion over which the dying individual would preside. The extended family and the community participated with visits, advice to the survivors, religious rituals, farewells, and blessings. It was a final affirmation of the person and his or her place in society.”
But modern medicine gave the script a total rewrite. Many of the dreadful infectious diseases which claimed lives in the past were either conquered or at least partially neutralized.
By 1970, two-thirds of American deaths took place in hospitals or other healthcare related institutions. Death at home became much rarer.
Recent numbers indicate that the trend is once again reversing. Latest pre-COVID-19 statistics show that slightly more than 30 percent of our deaths are taking place in our homes. COVID will skew these statistics, but the trend is expected to continue.
Here’s the pressing question: where are we best off leaving this world?
On the surface, this is a no-brainer — who would choose a morbid hospital room over more familiar confines?
The cool efficiency of modern healthcare is intimidating. As Dr. Williams points out, medical care in hospitals and nursing homes is focused primarily on technical treatments.
“Too often in these institutions there is more attention paid to the diseases than to persons, more scientific curiosity about the machinery of the body than consideration of the human values that make a life worthwhile, more focus on subspecialty technicalities and analgesic adjustments with no one looking at the needs of the whole person,” Dr. Williams declares. “Being a patient alone in a hospital, subjected to multiple traumatic high-tech procedures and covered with tubes, has become a symbol of contemporary death…the dying patient is isolated and deprived of his deepest needs for emotional support.”
Dr. Christopher Kerr, chief medical officer of Hospice Buffalo, New York, agrees, saying that patients are treated on a kind of installment system, one organ at a time. But the overall human story, the very humanity at stake, is sometimes ignored.
Given that medical institutions hardly feature the full Dr. Kildare empathetic approach, it’s no surprise recent studies have found those who pass at home do so more peacefully. What’s more, the surviving significant others often experience less intense grief.
So, why shouldn’t most people stay home at the inevitable end?
Unfortunately, the reality of death at home isn’t the perfect alternative — it may be more personal, but it often encompasses painful unintended consequences.
Palliative care physician Richard Leiter writes: “Unless a family has significant resources necessary to hire aides or nurses, informal caregivers become responsible for everything…these tasks get harder as the dying person weakens.”
In addition to the caregiving price being steep for family and friends, Dr. Leiter sometimes finds that the patient can be “ambivalent” about passing at home, especially in front of younger family members.
Dr. Diane Meier, a professor of Geriatrics and Palliative Medicine, believes families often don’t comprehend what will be required in a death at home.
“They will need to understand how to manage symptoms like pain or shortness of breath or confusion,” Dr. Meier says. “They are on-call 24/7 and have to be alert to changes at all times…even with hospice care, families are the front-line caregivers. Ninety-nine minutes out of 100, the family is on its own.”
Deathcare professionals urge families to have frank, no-tiptoeing-around discussions about end of life issues well prior to a potential crisis. This discussion ought to include a review of specifics that impact all concerned: make certain everyone understands how difficult the circumstances can be.
Author Carol Bradley Bursack cites research which indicates 92% of our population recognizes the need for openly communicating about final care, but only 32% actually follow through. Failure to address the subject can make the process much more painful when it finally occurs.
Dying at home may be preferred by both the patient and the family, but, unfortunately, it’s not always feasible or appropriate. Talking to a palliative care specialist can help families work through these challenging decisions.