Decades of medical and societal changes have shifted the landscape of end-of-life care in the United States. The common perception is that most people die in hospital beds, but examining death certificate data reveals a complex distribution of fatalities across institutional and residential settings. Analyzing these percentages provides a clearer picture of the role facilities like nursing homes play in the final stages of life for many individuals.
Current Prevalence of Nursing Home Deaths
The percentage of all American deaths that occur specifically within a nursing home has been relatively stable, hovering around one-fifth of the total for many years. Data indicated that approximately 19.1% of all deaths in the United States took place in a skilled nursing facility (SNF) or a long-term care setting. Nursing homes are primarily designed for individuals requiring complex medical care, rehabilitation, or long-term assistance with daily activities. This figure is distinct from assisted living facilities, which provide less intensive medical supervision.
For the oldest segment of the population, particularly those aged 85 and older, a nursing home is a much more common site of death. Residents often have multiple chronic conditions, contributing to the high mortality rate within the facilities themselves. The proportion of all US deaths occurring in these facilities remains a consistent data point in end-of-life statistics.
The Full Picture: Where Most Americans Die
To understand the role of nursing homes, it is necessary to view the full distribution of death locations across the country. The nursing facility accounted for the second-largest institutional location of death. Hospitals, including medical centers and inpatient wards, still account for a substantial portion of deaths, representing around 35.7% of the total. The hospital remains the single most common location for a person to die in the US.
The fastest-growing location category is the private residence, or home, which accounts for approximately 31.1% of all deaths. This trend reflects a growing preference among Americans to die at home, often supported by hospice services. Hospice care focuses on comfort and symptom management. While some deaths occur in free-standing hospice facilities (7.9% of the total), the majority of hospice services are delivered in the patient’s home or a nursing facility.
Historical Shifts in End-of-Life Locations
The current distribution of death locations represents a significant historical shift over the last half-century. Beginning in the mid-20th century, the hospital was the dominant location, with over 50% of Americans dying in an acute care setting in 1980. Since then, a steady movement away from institutional deaths has fundamentally reshaped end-of-life care. The proportion of deaths occurring in a hospital declined consistently, dropping to around 41% by the late 1990s.
This change is largely attributable to the growth of the hospice movement and evolving patient preferences. Hospice care emphasizes palliative care over curative treatment, providing the necessary medical support for death to occur outside a traditional hospital environment. Policy changes and insurance reimbursement models have also increasingly supported home-based care, propelling the home to become the second most common place of death.