More Californians are dying at home. Another Covid “New Normal”?

The covid-19 pandemic has spurred a surge in the percentage of Californians dying at home rather than in hospitals or nursing homes, accelerating a slow but steady rise that goes back at least 20 years.

The recent surge in home deaths began in 2020, the first year of the pandemic, and the rate has continued to rise, with hospital and nursing home deaths likely helping to explain the initial change. It has lasted longer than a strict lockdown. Nearly 40% of California deaths in the first 10 months of 2022 occurred at home, from about 36% overall in 2019, according to California Department of Public Health death certificate data. By comparison, data from the US Centers for Disease Control and Prevention show that in 1999, about 26% of Californians died at home.

This trend is amplified among California residents with serious chronic illnesses. About 55% of Californians who died of cancer at home in the first 10 months of 2022 will develop Alzheimer’s disease in the first 10 months of 2022, compared to 50% in 2019 and 44% in 1999. was about 43% of Californians who died in Did so at home, compared to 34% in 2019 and nearly 16% in 1999.

Nationally, the proportion of deaths that occur at home also jumped to 33% in 2020, rising to nearly 34% in 2021. National data for 2022 are not yet available.

The early, deadly California-wide spread of Covid does not, by itself, explain the increase in home mortality. The majority of those who died from covid died in hospitals or nursing homes. Instead, the surge appears to coincide, at least initially, with major policy changes in hospitals and nursing homes, according to medical experts.

Hospitals and nursing homes were completely closed to visitors, even the bedsides of dying patients were banned, leaving families in a difficult situation. Many chose to bring their loved ones back home. “It was devastating to see my mom dying in a nursing home. It’s the only way I can see my mom through her window,” he said. Barbara KearnsShe is a registered nurse who has written extensively on end-of-life care.

At the same time, in the first few years of the pandemic, fear of exposure to COVID-19 led many to avoid hospitals and, in some cases, neglect treatment for other serious conditions. It is also thought to contribute to the increase in home deaths.

Those who specialize in end-of-life care say it’s not surprising that this trend has continued even as visitation policies have eased. He said that he would like to die in a comfortable and familiar place, even if that doesn’t mean dying every second in a .

“Every time you ask, ‘Where do you want to be when you die? Or where do you want to go when your heart beats its last beat?'” ‘, ‘I want to enter a skilled nursing facility’. They’re all saying, ‘I want to stay home,'” he said. John TastadCoordinator of the Advanced Care Planning Program at Sharp HealthCare in San Diego.

Meanwhile, doctors who specialize in diseases that kill Americans, such as cancer and heart disease, are open to discussing home hospice as an option when alternative treatments are likely to sacrifice quality of life. It is

“Perhaps there has been a bit of a cultural shift where oncologists, pulmonologists and congestive heart failure physicians are referring patients to palliative care early to help manage symptoms and advanced care plans. ” he said. Dr. Puglia KashkuriDeputy Medical Director of Hospice at UC Davis Health.

The trend has created a booming industry. In 2021, the California Department of Health Care Access and Information listed 1,692 licensed hospice agencies. in its tracking databaseThis is a leap from the 175 institutions listed in 2002.

That much growth and the money behind it sometimes caused problems.Ah 2020 Survey Fraud and quality of care problems are common in California’s hospice industry, according to the Los Angeles Times. Subsequent status auditGovernor Gavin Newsom Bill signed in 2021 This temporarily suspended most new hospice licenses in an attempt to curb questionable kickbacks to doctors and institutions.

But when done right, home hospice can be a comfort for families and patients. Hospice usually lasts from a few days to several months. Services vary, but many offer regular visits by nurses, paramedics, social workers, and spiritual advisors.

Most people who use hospice have insurance through the Federal Medicare Program. How much Medicare pays varies by region, but usually he’s about $200 to $300 a day. Dr. Kai Romeronon-profit chief medical officer Hospice by the Bay.

To find quality end-of-life care, Andrea Sankara professor at Wayne State University andDying at Home: A Family Guide to Caregiving,” I recommend looking for a nonprofit provider and preparing a list of questions: How often do nurses make in-person visits? Under what circumstances do patients have access to doctors? What kind of help can I get in a crisis?

Hospice providers provide important guidance and support, but families should be prepared to shoulder most of the care. “We need a much more evolved family system to be able to come together to meet all our needs,” said Tastad of Sharp Healthcare.

Several end-of-life experts said they expect the percentage of Californians choosing to die at home to continue to rise, citing a variety of factors. telemedicine Make it easier for patients to consult doctors from home. And his two powerful forces in American health care, insurance companies and the federal government, have come to view dying at home as an affordable alternative to lengthy hospital stays.

Phillip Reese is a data reporting specialist and assistant professor of journalism at California State University, Sacramento.

This story was produced by KHNto issue california health linean editorially independent service of California Health Care Foundation.