Where Do Americans Die? Home, Hospital, Nursing Facility, and Hospice

Where a person dies shapes the last days for the whole family. It affects who can be there and what help is available. This article uses national data to show where Americans die and how that has changed.

Where do most Americans die?

At home, as of 2017. Researchers Sarah Cross and Haider Warraich studied nearly 35.2 million deaths from natural causes between 2003 and 2017. They published their findings in the New England Journal of Medicine in December 2019. Home had become the most common place of death, ahead of the hospital. Hospice News reports that this had not been true since the early 20th century.

How did the numbers change?

Place of death	2003	2017
Hospital	39.7%	29.8%
Home	23.8%	30.7%
Nursing facility	23.6%	20.8%
Hospice facility	0.2%	8.3%

The study counted deaths from natural causes, which means deaths from illness. It does not include deaths from injuries. The remaining share happened in other settings, which the data group together as “other.”

Why did home deaths rise?

The data do not prove one cause. Hospice News notes that the rise in home deaths went along with a rise in hospice use. Deaths in hospice facilities grew from about 5,400 in 2003 to about 212,700 in 2017. Warraich told the outlet that the shift means families and caregivers at home need more support.

Does the place of death depend on the illness?

Yes. People with cancer had the greatest odds of dying at home or in a hospice facility, and the lowest odds of dying in a nursing facility. People with dementia had the greatest odds of dying in a nursing facility. People with respiratory disease had the greatest odds of dying in a hospital. People who died of stroke had the lowest odds of dying at home.

A separate analysis of deaths from cardiovascular disease found the same direction of change. Home deaths in that group rose from 21.3% to 30.9%, and hospital deaths fell from 36.5% to 27.3%, according to Healio’s report.

Who is more likely to die at home?

Older patients, men, and white patients had higher odds of dying at home. Younger patients, women, and patients from racial and ethnic minority groups had lower odds. In the cardiovascular analysis, Black and Hispanic patients also had higher odds of dying in a hospital than white patients. The studies describe these gaps but do not explain them.

What does “home” mean in the data?

Not always a private house. McKnight’s Senior Living reports that “home” can include assisted living. Warraich also noted that the data do not show whether a person had hospice care, or whether someone who died at home had just been discharged from a hospital. The data also do not capture what patients wanted.

What do these numbers leave out?

Three things. First, they end in 2017, so they do not show later years or the effects of the pandemic. Second, place of death says little about the quality of care. Third, they do not tell us what people prefer. In a 2000 national survey of seriously ill patients, family members, and care providers, dying at home ranked last among the factors people rated. Freedom from pain ranked first. For more, see When You’re Dying, What Makes Life Worth Living?.

Where can I learn more?

See What Happens If You Die Alone at Home?, Hospice vs. Palliative Care, and What Is a “Good Death”? What Research Says.