title: Factors associated with end-of-life by home-visit nursing-care providers in Japan.
abstract: OBJECTIVE
  Home-visit nursing-care services in Japan are expected to provide home hospice services for older patients with non-cancer diseases. The aim of the present study was to examine factors that contribute to the provision of end-of-life care by home-visit nursing-care providers in Japan.
  
  
  METHODS
  The present retrospective study was carried out using nationally representative cross-sectional data from the 2007, 2010, and 2013 Survey of Institutions and Establishments for Long-Term Care. A total of 138 008 randomly sampled home-visit nursing-care service users were included in this analysis. End-of-life care (study outcome) was defined as the provision of nursing-care within the last month of life.
  
  
  RESULTS
  Of the 138 008 patients at home, 2280 (1.7%) received home-based nursing care within the last month of life, and end-of-life care was offered primarily to cancer patients (n = 1651; 72.4%). After accounting for patient characteristics, patients were more likely to receive end-of-life care when they used home-visit nursing-care providers that had a greater number of nursing staff or were located in a region with fewer hospital beds.
  
  
  CONCLUSIONS
  Among home-visit nursing-care providers, the nursing staff ratio and the availability of hospital beds were related to the provision of end-of-life care. Home-visit nursing-care providers should establish specialist hospice care teams with enhanced staffing ratios to allow for the adequate provision of home-based end-of-life care. A community-based network between home-visit nursing-care providers and hospitals should also be established to attain an integrated end-of-life care system for elderly populations in regions with more hospital beds. Geriatr Gerontol Int 2017; 17: 991-998.
authors.affiliation: Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Miharu
authors.identifier: http://orcid.org/0000-0001-6200-9279
authors.initials: M
authors.lastname: Nakanishi
authors.affiliation: Mental Health and Nursing Research Team, Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Niimura
authors.affiliation: Mental Health Promotion Project, Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nishida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D006792:House Calls; D006801:Humans; D007564:Japan; D008297:Male; D013727:Terminal Care / Q000458:organization & administration*
keywords: end-of-life care; home nursing; hospice care; long-term care; palliative care