For the first time since the early 20th century, the home has surpassed the hospital as the place where people most often die in the United States, and “home” may include assisted living, according to research recently published in the New England Journal of Medicine.

“These findings should lead to prioritizing improvements in access to high-quality home care for older Americans with serious illnesses,” Sarah H. Cross, MSW, MPH, of the Duke University Sanford School of Public Policy, and Haider J. Warraich, M.D., of the Veterans Affairs Boston Healthcare System, wrote in a letter to the editor in the Dec. 12 edition of the medical journal.

The researchers studied data from the Centers for Disease Control and Prevention and its National Center for Health Statistics covering natural deaths in the United States between 2003 and 2017.

Of all deaths, deaths in hospitals decreased from 40% in 2003 to 30% in 2017, and deaths in nursing facilities decreased from 24% to 21% of total deaths during that time. Deaths at home, however, increased from 24% of total deaths in 2003 to 31% in 2017, and deaths in hospice increased from less than 1% to 8% of the total during that time.

The researchers suggested that some death certificates from which data were derived could have classified assisted living communities as homes. Also, they said that the location where hospice services were provided could not be determined from the data. 

Deaths in the time period studied primarily were due to cardiovascular disease (29%), cancer (25%), respiratory disease (11%), dementia (8%) and stroke (6%), they said.