Japan's policy of promoting end-of-life care in nursing homes: impact on facility and resident characteristics associated with the site of death.
OBJECTIVE
To evaluate the impact of the policy to encourage nursing homes to provide end-of-life care by comparing facility and resident variables associated with dying within the nursing home and not in hospitals, and by comparing life sustaining treatment (LST) respectively provided.


METHODS
Questionnaires mailed to an 11% random sample of 653 nursing homes in 2009. Facility characteristics from 371 nursing homes (57%) and resident characteristics of the 1158 who had been discharged due to death were obtained from 241 facilities (37%).


RESULTS
Facility characteristics related to dying in nursing homes were their policy of providing end-of-life care and physicians being based in home care supporting clinics. Resident characteristics related were not having pneumonia as the cause of death, the family's preference of the nursing home as the site of death and agreement within the family. Preferences on the use of LST were adhered more in residents who had died in nursing homes.


CONCLUSIONS
Although the percentage of residents dying within the facility has increased, the nursing home as a site of death still composes only 3.2% of the total. To increase the latter, nursing homes should refocus their function to providing end-of-life care to those not preferring aggressive treatment.
Department of Health Policy & Management, Keio University School of Medicine, Japan. nikegami@a5.keio.jp
Naoki
N
Ikegami
Sumie
S
Ikezaki
D000369:Aged, 80 and over; D002423:Cause of Death; D003625:Data Collection; D003643:Death; D005190:Family / Q000523:psychology; D005260:Female; D006291:Health Policy; D006699:Home Care Services / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan; D008297:Male; D009735:Nursing Homes / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000331:legislation & jurisprudence / Q000523:psychology / Q000706:statistics & numerical data