Where People Die: A Multilevel Approach to Understanding Influences on Site of Death in America

Abstract

Despite documented preferences for home death, the majority of deaths from terminal illness occur in hospital. To better understand variation in place of death, we conducted a systematic literature review and a multilevel analysis in which we linked death certificates with county and state data. The results of both components revealed that opportunities for home death are disproportionately found in certain groups of Americans; more specifically, those who are White, have greater access to resources and social support, and die of cancer. From the multilevel analysis, the higher the proportion minority and the lower the level of educational attainment, the higher the probability of hospital death while investment in institutional long-term care, measured by regional density of nursing home beds and state Medicaid payment rate, was associated with higher probability of nursing home death. These results reinforce the importance of both social and structural characteristics in shaping the end-of-life experience.

Intervention to Improve Care at Life’s End in Inpatient Settings: The BEACON Trial

“…[26][27][28][29][30][31][32] In an environment focusing on "cure," transition away from disease-modifying treatments to symptom control can seem counterintuitive. Because most Americans are likely to die in a hospital or nursing home, 20,33,34 there is a compelling need to address processes of care for actively dying patients in inpatient settings.…”

The Going Home Initiative: Getting Critical Care Patients Home With Hospice

“…[37][38][39][40][41][42] However, most patients, if given the choice, would prefer to die at home. 39,[43][44][45][46][47][48][49][50] Although dying at home was a common phenomenon at the end of the 19th century, 51 we could find no contemporary initiatives focused on getting patients home from the ICU. Consequently, our ICU palliative care committee (PCC) sought to provide patients a peaceful death both in the unit and perhaps at home.…”

“…(Critical Care Nurse. 2011;31 [5]: [46][47][48][49][50][51][52][53][54][55][56][57] trillion or 17.6% of the gross domestic product of the United States. The cost of caring for patients in ICUs in the United States has been estimated as 15% to 25% of all US hospital costs [23][24][25] and from 1% to 2% of the gross national product.…”

Recognising patients who will die in the near future: a nationwide study via the Dutch Sentinel Network of GPs

“…4 Given the increasing incidence of cancer, congestive heart failure, dementia, and other lifelimiting conditions in general practice, [5][6][7] GP care at the end of life is pivotal, 8,9 particularly for patients who choose to die at home, [7][8][9] and many do. 10 Timely awareness of death in the near future has been associated with fewer hospitalisations, more palliative care referrals, and better bereavement adjustment. 11,12 However, not much is known about GPs recognising the final phase in patients who die at home, 13 especially among those with non-malignant diseases.…”