title: Nursing homes and end-of-life care in Japan.
abstract: OBJECTIVE
  To describe end-of-life care in Japanese nursing homes by comparing facility and characteristics of residents dying in nursing homes with those who had been transferred and had died in hospitals, and by comparing the quality of end-of-life care with hospitals and with their respective counterparts in the United States.
  
  
  METHODS
  National sample of 653 nursing homes with responses from 371 (57%) on their facility characteristics, 241 (37%) on their resident characteristics, and 92 (14%) on the residents' quality of life. All 5 hospitals in a city 80 miles from Tokyo cooperated.
  
  
  METHODS
  Nursing home staff answered questionnaires on facility and resident characteristics. Resident level data were obtained from 1158. The questionnaire on the quality of care was responded to by 256 (63%) of the decedents' families in nursing homes and 205 (48%) in hospitals.
  
  
  METHODS
  Facility characteristics included items on physicians, nurse staffing, and the facility's end-of-life care policy. Resident characteristics included basic demographics, level of dementia, and resident's and family's preference for the site of death. The Toolkit was used to measure the quality of end-of-life care.
  
  
  RESULTS
  The proportion of those dying within the nursing home was related to the facility's policy on end-of-life care and the family's preference. The quality of end-of-life care in nursing homes was generally better than in hospitals, and than in their respective counterparts in the United States.
  
  
  CONCLUSIONS
  Financial incentives by the Japanese government to promote end-of-life care in nursing homes may have contributed to increasing the proportion of deaths within the facility. The quality of care in nursing homes was evaluated as being better than hospitals.
authors.affiliation: Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan. Electronic address: nikegami@a5.keio.jp.
authors.forename: Naoki
authors.initials: N
authors.lastname: Ikegami
authors.forename: Sumie
authors.initials: S
authors.lastname: Ikezaki
mesh_terms: D017677:Age Distribution; D000369:Aged, 80 and over; D003258:Consumer Behavior; D003704:Dementia / Q000453:epidemiology; D005190:Family; D005260:Female; D006801:Humans; D007353:Insurance, Long-Term Care; D007564:Japan; D008297:Male; D008503:Medical Staff / Q000706:statistics & numerical data; D009735:Nursing Homes / Q000706:statistics & numerical data*; D009740:Nursing Staff / Q000706:statistics & numerical data; D016134:Organizational Policy; D057240:Patient Preference / Q000706:statistics & numerical data; D011787:Quality of Health Care; D017678:Sex Distribution; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*; D014481:United States; D000078329:Workforce
keywords: End-of-life care; Toolkit; financial incentives; quality of care