Nearly everyone who is asked where they want to spend their final days says at home, surrounded by people they love and who love them. That's the consistent finding of surveys and, in my experience as a doctor, remains true when people become patients. Unfortunately, it's not the way things turn out. At present, just over one-fifth of Americans are at home when they die. Over 30 percent die in nursing homes, where, according to polls, virtually no one says they want to be. Hospitals remain the site of over 50 percent of deaths in most parts of the country, and nearly 40 percent of people who die in a hospital spend their last days in ICU, where they will likely be sedated or have their arms tied down so they will not pull out breathing tubes, intravenous lines, or catheters. Dying is hard, but it doesn't have to be this hard.