Death Better Than Nursing Home, 3 Of 10 Hospitalized Patients Say

Surveys find that most people would rather continue living at home than go to a nursing home. The aversion to such a facility is so strong that a new study of seriously ill people in hospitals found that 30 percent of those surveyed said they would rather die than live permanently in a nursing home.

The study was the first to ask seriously ill patients to state a preference for either living in a nursing home or dying. The findings come from the Support study, the largest investigation in the United States of decision-making at the end of life.

For the study, 3,262 patients at five hospitals across the country were asked, “Would you be very willing, somewhat willing, somewhat unwilling, very unwilling, or would you rather die than put up with living in a nursing home all the time?”

Twenty-six percent of the respondents said that they would be very willing or somewhat willing to live in a nursing home, and 37 percent said that they would be somewhat or very unwilling to do so. Thirty percent said that they would rather die than live permanently in a nursing home, and 6 percent said they were undecided.

The study also found that patients’ families and doctors often misjudge the patients’ feelings about nursing-home care. When asked if a patient would be willing to live permanently in a nursing home, family members were correct only 35 percent of the time, and doctors just 18 percent of the time.

Dr. Thomas Mattimore, associate clinical professor of medicine at the University of California School of Medicine in Los Angeles and the study’s lead author, said that in many cases the decision for nursing-home care lies not with the patient but with insurance coverage. He said that many insurance plans pay for nursing-home care but not for 24-hour home care.

Still, he said, the findings have implications for the medical treatment a patient or his family chooses at the end of life.

“In our study, the patients who preferred aggressive care were those who were willing to go to a nursing home,” he said.