How Do Americans Spend the Last Few Years of Life?

Insights from the Final Three Years of Life of Americans Who Passed Away in 2018 Provide a Glimpse into the Dying Process in the United States

New study examines the final years of Americans’ lives and how they experience death.

News Picture: How Do Americans Die?

When it comes to the end of life, one might expect a multitude of different paths people take. However, a recent analysis conducted by a team at Rutgers University in New Jersey has shed light on the last three years of life for Americans who passed away in 2018. The research focused on approximately 200,000 Medicare beneficiaries, providing valuable insights into the different trajectories individuals took in their final years.

Home Sweet Home

According to the study, a majority of Americans (59%) spent their last three years at home, surrounded by their loved ones and receiving care from family and friends when needed. Surprisingly, most of these individuals did not require professional care until the final year of their lives. This highlights the importance of familial support and demonstrates the preference many have for staying in familiar surroundings. 🏡

Skilled Home Care

Another group discovered in the analysis accounted for 27% of those who died in 2018. These individuals received “skilled home care” over the course of their final three years. While they remained in the comfort of their own homes, they received assistance from skilled professionals (such as nurses) to ensure their care needs were met. This category represents those who required more specialized care than what could be provided by family and friends alone. 👩‍⚕️

Institutional Care

A smaller portion of Americans (14%) required “institutional care.” These individuals spent their last three years in a nursing home or hospital, relying on paid professionals for the majority of their care. This category may include individuals with complex medical needs or those who preferred to avoid burdening their families with caregiving responsibilities. It’s important to note that institutional care is not necessarily indicative of a lack of desire for home care but rather a specific choice made by certain individuals. 💼

Demographic Patterns

The study also uncovered interesting demographic patterns among those who required professional care. For instance, individuals in need of professional care (whether in-home or institutional) were more likely to be female, Black, and reliant on Medicaid. These findings could reflect various clinical and policy factors that determine the distribution of care among different population groups. Understanding these patterns is crucial for effective advance care planning. 💪

Designing Interventions for Individualized Care

The authors of the study emphasize the significance of these findings for developing interventions that cater to individual preferences and needs. While the majority of individuals prefer to stay at home with minimal professional assistance, a significant minority seeks professional care to alleviate the burden on family and friends. By recognizing and appreciating these differences, we can ensure that individuals receive the care that aligns with their desires. 👨‍⚕️

To learn more about this study and its implications, you can refer to the original research paper published in the journal BMC Geriatrics.


Q&A: Addressing Common Concerns

Q: Is it better to receive care at home rather than in a nursing home?
A: The preference for home care over nursing home care is subjective and varies from person to person. While some individuals cherish the comfort and familiarity of their own homes, others may require the specialized care and resources available in nursing home facilities. It’s important to consider personal preferences, health conditions, and available support systems when making this decision.

Q: What factors contribute to the need for professional care?
A: Several factors can contribute to the need for professional care, including complex medical conditions, the availability of family support, financial considerations, and personal preferences. It’s essential to evaluate individual circumstances to determine the most appropriate level of care.

Q: How can advance care planning help?
A: Advance care planning allows individuals to document their preferences for medical treatment, should they become unable to express their wishes in the future. By engaging in advance care planning discussions with loved ones and healthcare providers, individuals can ensure their desires are respected and receive care aligned with their values.


The study conducted by researchers at Rutgers University provides valuable insights into how Americans spend their last few years of life. By examining the trajectories of individuals who died in 2018, the research sheds light on the preferences and patterns of care among different groups. Whether it’s receiving support at home, engaging skilled professionals, or opting for institutional care, each decision is shaped by individual circumstances and desires.

Remember, it’s crucial to have open conversations about end-of-life care with yourself, your loved ones, and your healthcare providers. Together, we can pave the way for personalized care that takes into account the diverse needs and preferences of individuals nearing the end of their journey.


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