More Deaths At Home: How Does That Impact Hospice?

The New England Journal of Medicine recently reported that more Americans are dying of natural causes at home instead of hospitals for the first time since the early 1900s. For those of us who work for or with hospice organizations, that’s big news. But why has this shift finally come to pass and what are the potential implications?

This new dynamic may signal both great opportunities and different challenges for hospice providers adjusting to changing needs and demands.

First of all, the latest data doesn’t mean the majority of people are dying at home instead of all other places combined. According to 2017 data from the Centers for Disease Control and Prevention and the National Center for Health Statistics, 31.7% of Americans died at home versus 29.8% at hospitals. (The data drops significantly from there, with 20.8% dying at nursing facilities.)

Yet, home has become the leading place where Americans die of natural causes. What are some of the ripple effects we see related to this trend?

1. A growing acceptance of hospice. One conclusion from the Journal report stated, “The rise in home deaths documented in our study is likely a result of greater use of hospice along with broader efforts to de-medicalize and improve end-of-life care.” With concerted efforts by many advocates in the hospice field, families are slowly being educated on the truth about hospice care, helping to relieve some of the fear and barriers to acceptance. Medicare data shows that family/self referrals have grown from 10.1% to 12.4% during the past few years. Yet, there’s still plenty of room for further improvement as only 48% of Medicare recipients received at least one day of hospice care and were enrolled in a hospice program at their time of death. What’s more, a 2018 Stanford study showed that 80% of Americans prefer to die at home. We need to consistently keep educating families about the advantages of hospice care and encouraging engagement as early as appropriate – so patients are better prepared to live more fully before dying at home.
2. Increasing inability to afford inpatient hospital care. A significant number of people still die in hospitals – and some patients prefer to be there, especially if their condition requires intensive or high acuity care. However, a growing number of patients and their families may be unable to afford an inpatient stay until death, especially if it ends in a high-cost ICU. With hospitalization costs continuing to rise along with higher deductibles and co-pays for many consumers, home may be the only “affordable” place to die … even if it isn’t the patient’s preference. Hospice providers who can partner the most effectively with their regional hospitals to transition patients from hospital to home – and be prepared to handle more high acuity conditions in their patient mix – can be better positioned to meet the needs and wishes of patients.
3. An urgent need to better educate and train family caregivers. As more Americans die at home, the need to better prepare family members to be primary caregivers increases. Experts are predicting a growing shortage of professional caregivers to meet the demand as the high volume of Baby Boomers age, with the responsibility falling more and more on family caregivers. Are you in a position to help give greater support to family caregivers? As the need grows, so does your opportunity to engage with families earlier in the journey of a serious illness.