More americans dying at home than in hospitals

With adults 65 and older expected to exceed the number of children by 2034 – a first in U.S. history – Banach predicts the home-death trend will continue. And the hospice industry, which has

reported staff shortages in recent years, will need to expand to meet the demand. "It's our goal to make sure that when people go home, they actually have someone to provide care

for them,” Banach says. Currently, Medicare covers the cost of hospice care for patients who have a life expectancy of six months or less. NHPCO data shows that patients spend an average of

76 days in hospice care. More people could benefit from hospice care earlier, Warraich says, but predicting how long a patient has to live prevents many physicians from recommending it.

Given how treatments for serious diseases have evolved, “it can be really hard to know when a patient has a very limited life expectancy,” Warraich says. "I think one of the things that

a lot of people are talking about and I think needs to be tested is that instead of using prognosis as a way of [determining] who should be enrolled in hospice, I think we need to focus on

patient's need and symptom burden,” he adds. Enrolling patients in hospice earlier also means physicians need to prioritize honesty and maintain an open dialogue with patients

throughout their illness; admittedly, Lester says, this can be difficult. "We need to use the D word,'” she says, referring to “death.” “Doctors and nurses use a lot of euphemisms

and I think it cheats the patients and their families out of an opportunity to decide how they want those last minutes, hours, days, months to be.” Allowing hospice providers to administer

more services and medications than they are permitted to do now could also open access to more patients and ease the burden on family and friends, Warraich says. Experts don't recommend

dying at home without the help of hospice or other professionals. Living with someone who is dying is “absolutely draining,” Banach says. And hospice care ensures that caregivers don't

burn out. It also gives patients and caregivers the tools they need to get through times of pain and discomfort, when they otherwise might feel compelled to call 911. "You can say all

you want that you want to keep your loved one home, or that you want to be at home, but if you start to have difficulty breathing or pain, you're going to feel the need to help,” Lester

says, “It's not something that anyone should be doing without the support of a system and a team.”