When I took my first pastorate almost forty years ago, one noticeable aspect of it was that when there was ministry to be done for those who were near death, it almost always occurred in an insitution, primarily hospitals. I made countless visits to intensive care units to pray for church members who were near death. It was common in those days for the member to be connected to all manner of monitors, tubes, and other medical equipment. One family member, perhaps two, might be in the room with their loved one while others sat in the waiting room and maybe rotated in and out of the ICU unit.
It was the way things were done in those days where most Americans died in hospitals (around 60% in 1980) or other institutions (around 75% altogether) rather than at home. A far smaller percentage died at home. In those early years of ministry, it was quite unusual for me to make home visits to a church member who was near death and who eventually died at home. The last was the best.
Things have changed over the decades and I read that more Americans are dying at home than in the hospital, according to a recent study. The figures are 30.7% at home, 29.8% at a hospital, around 20% at a nursing home or other institution.
Have you noticed the change?
In my own family two grandparents died at home but suddenly, unexpectedly. Two died after long illnesses in institutions. My father died in a hospital hospice unit. My mother died in her own bed in her own home.
While it’s not always possible to be at home, it is much preferred to an institutional setting. The atmosphere is more relaxed. Family members and friends have easier access. It is less busy and quieter. I suppose writing this is stating the obvious but the trends are clear. Some studies show 80% of Americans prefer to die at home.
Hospice has grown greatly in America over the years, a good thing. When my father had a serious medical event in a nursing home where he had been for a couple of weeks, he was unconscious and was taken to the hospital ER where the doctor, in one of the most memorable sentences I will ever hear, said, “We don’t expect your father to leave the hospital alive.” The decision was to put him in one of the hospital rooms set aside for hospice patients. Family members had time to gather. It was a suite with a connected room for family, not quite as comfortable as home but much better than the ER or ICU.
There are a lot of factors involved, including costs, who pays for it, local conditions and, so I read, the socioeconomic status of the dying person and their family. There are also conflicting data but no one disputes that more people are dying at home these days.
What’s your experience? Have you noticed changes?
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One of the regrets I have about pastoral ministry is that I did not take the opportunity early on to do some training in this area. My course of MDiv study didn’t include much of this. The practical ministry class covered other things like how to dunk a baptismal candidate without messing up.
I worked, and I do not like that term, for a local hospice for 22 years. A stroke I had required me to resign. It was a wonderful calling and I was with several patients when they took that last breath and entered into eternity. It was always an awesome experience. I could tell those who knew the Lord Jesus and those who did not. I would have liked to share the Gospel with all of them, but my agency would not permit me to do so. One man though was a Southern Baptist, having moved here from Atlanta. Yes Charles Stanley was his pastor. We hit it off BIG time, and all we ever talked about was our faith. He was a special brother, and to this day I still miss him. His daughter gave me his well marked up KJV, and I cherish it.
Being at home was always preferable, and the ease of caring for them was much more relaxed. My years caring for the dying will always be a highlight of my life.
You can mark me down as a big fan of hospice care. I’ve had experience with hospice in my family, my wife’s family, and our church family. The hospice caregivers and chaplains do a great job. I agree dying at home is a trend, and I believe most folks would rather die at home, surrounded by family and friends, if they had the opportunity to choose. I’ve recommended hospice care to lots of folks.
I am also a big fan of hospice care. My Dad and step-mom had moved into an “assisted living” facility about a year prior to his death. When his doctor told him about the seriousness of a condition he had and that it was just a matter of time, he went into the hospice care at his residence which was absolutely wonderful in tending to his needs, especially helping with pain. His pastor had just left after a visit and his wife was with him when he passed away.
During a period of time when, as a church staff member, I was the “interim” during the week, tending to pastoral care after our pastor resigned, one of our members who had cancer found out that it was terminal, and that the blood transfusions he was getting was the only thing keeping him alive. He decided not to continue the transfusions but his condition required 24 hour care. He went into a hospice facility that was very home-like and which made it very comfortable and easy for his family and friends to come. The doctor gave him a week after he stopped transfusions and medication, but I think the atmosphere of where he was helped and he was there almost a month before he passed away. I can’t think of any other situation I’ve ever been in when someone asked me to pray with them and help them with a decision like that. Had he stayed on the transfusions, it might have given him six more months, though there was no hope for recovery at all. But he was thinking that if he stopped the transfusions, they would be available for someone else who might be able to make better use of them. And I can say that no training I’d had in college or seminary prepared me for that.
We are willing and have the desire to serve and change to be better Church and State. But, its own repentance and reformation are required but give up now. God bless. Thank you.
” Have A Happy Merry Christmas & Happy New Year “
William,
Yep. It’s rare these days that I visit someone in the hospital for their last moments of on earth – most of the time it is either at home or a hospice unit.
I do have a bit of a jovial question for you… You posted this: “ The figures are 30.7% at home, 29.8% at a hospital, around 20% at a nursing home or other institution.”. Assuming that we are talking about sick people here in the study… Where did the other Approx. 20% die?
Hospice facility and “other”. I suppose “other” could be a family member’s home. I didn’t drill down to get to that. Good observation.
I am a retired hospice nurse. The enormous benefits of hospice are far too numerous to list in this space. A great new resource for everyone who knows someone who will die (all of us) is a book by Dr. B.J. Miller, “A Beginner’s Guide to the End”. It’s $25 on Amazon, but when you read it you will have a more complete understanding of the process. I happen to believe it should be the the text book for a required class in every college and university in the nation.
In about 17 years as a pastor, I have seen the stats you give as pretty accurate. Almost equal between home and an institution. And with the great work of hospice folks, I only see home deaths increasing as people are able to pass in that more comfortable setting. It is very rare to find a hospital or nursing home that comes close to home. But the one common thread in all end of life scenes — no matter where it is, you want loved ones with you. And as a pastor, it’s one of the highest honors to be included and serve a family in those hours.
William,
Great article, I have definitely seen a shift over the last few years. The hospices folks are truly caring professionals. I am not certain but I think that insurance parameters have a lot to do with many staying in their homes.
woody
Both my parents had wonderful hospice care; one in-home and one at a facility.
Here’s one thing (of many) that I learned. When hospice is suggested, there’s usually someone who is horrified and says “NOT HOSPICE!!!” That person may either 1) be expressing grief, and fear of death, 2) be objecting to a terminal diagnosis (although not all hospice is for terminal conditions) and regarding it as giving up on their loved one, and/or 3) doesn’t know what hospice is/does. I’m glad more and more people have wonderful experiences to tell about hospice. And I’m grateful for pastors who are sensitive to family dynamics and can be a calm presence when emotions are high.
Four units of Clinical Pastoral Education gave me more tools for walking with people through death than nearly 8 years of theological education. It was a year of applied theology.