Both my parents passed away in an institution in an institutional bed. One in a hospital bed in a critical care unit, the other in a nursing home bed. The Wall Street Journal reports that increasingly, people are choosing to die at home in their own bed. The Journal asks whimsically, “is that a good thing?”
Surveys find that most people would prefer to die at home, in a familiar space. A study published in eClinicalMedicine, a Lancet journal, detected an increase across numerous countries and decided it was a positive outcome.
Research suggests that 70% of Americans want to die at home. More seem to be doing so, at least partly owing to the Covid-19 pandemic. In a study of where people died in 32 countries between 2012 and 2021, published in Lancet’s eClinicalMedicine in January, the authors found a rise in home deaths in most countries, including the U.S., during the pandemic, which they largely interpreted as progress.
There are plenty of reasons for death to occur outside of an institution like a hospital. Hospitals are impersonal. Hospitals are expensive. You do not need lifesaving resources at the point it no longer is likely to do you any good. Indeed, when patients enter hospice care they agree to no longer receive lifesaving care and will only receive palliative care to make their death more comfortable. The writer, a palliative care physician, reports that the location of death does not define whether it’s good or bad, however.
The truth is more complicated. Now, 10 years into my career as a palliative medicine physician, I know that there is much more to a “good” death than its location. Presuming a home death is a success obscures important questions about the process: Did this person die comfortably? Did their caregivers have the resources and guidance they needed? Was dying at home a choice or simply the only option?
Dying well at home is not as easy as it sounds. The process requires resources that are not always available. The following is an observation that occurred during the covid pandemic.
Some patients lacked local family and couldn’t afford paid caregivers. Others lost their jobs and homes in the pandemic. Some struggled to access pain medications because local pharmacies, besieged by robberies and supply-chain problems, didn’t carry them.
While home deaths may sound more pleasant to hospice patients, they can be taxing to families. Hospice care is sometimes hospital based and can also be delivered in nursing homes. However, it mostly occurs at home.
Dying at home, then, is often a result of circumstance rather than choice. As policymakers consider the best ways to support a successful death, they should listen to the stories of actual patients and caregivers.
Not everyone is a candidate for a death at home. Some hospice patients live in cramped apartments. Some have roommates who may not want to be part of the process. Dying can be painful, messy even. It’s often not pretty but can be made much better with support staff, who have access to the resources needed. Dying at home should not be the primary goal. Rather, dying a comfortable death with dignity should be the goal. For some people that can be done at home, but others may not have the resources or support to ensure a good death at home.
Read more at WSJ: More People Are Dying at Home. Is That a Good Thing?