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?
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.