Abstract
BackgroundAlthough the Japanese government has expanded its ‘Elderly Housing with Care Services’ (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents’ deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths.MethodsOur cross-sectional study involved all EHCS (N = 412) in Japan’s Tokyo, Kanagawa prefecture and used self-administered questionnaire data that the EHCS directors completed. In addition, we accessed the national statistics related to the municipal characteristics of the cities where the EHCS were located. These sources provided information about health care provision for the residents as well as facility/resident/regional characteristics that could potentially be associated with residents’ deaths in the EHCS. Based on this information, a sequential multiple logistic regression analysis was performed. First, we included in-facility health care provision (presence of nursing staff) and facility/residents/regional characteristics in Model 1. Next, visiting nurse agency’s care provision was included in Model 2. Finally, we included community hospitals or clinical care provision in Model 3.ResultsOne hundred and fifty-four facilities answered the questionnaire (response rate: 37.4%). A total of 114 facilities were analysed. In-facility residents’ deaths occurred in more than half (54.4%) of the facilities. After adjusting for all variables (Model 3), end-of-life (EOL) care provision from community hospitals or clinics, the number of years since establishment and the number of residents were significantly associated with residents’ deaths. In Model 2, visiting nurse’s EOL care provision was significantly associated with residents’ death.ConclusionOur results suggest that in order to accommodate residents’ deaths, the government or the facility’s directors should promote the cooperation between EHCS facilities and community hospitals or clinics for in-residents’ EOL care. Furthermore, as the results suggest that community nurses contribute to the occurrences of death by collaborating with the physician, promoting cooperation with visiting nurse agencies may be also needed.
Highlights
The Japanese government has expanded its ‘Elderly Housing with Care Services’ (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities
The present study aimed to identify the factors associated with in-facility resident deaths within the EHCS, especially in the areas that are expected to be confronted with a large increase in the number of deaths
Regarding receiving care services from community hospitals or clinics/visiting nurse agencies’, we have described the original items that were categorized as ‘have received care’ in Table 1; the original items were only included for the descriptive analysis because this study only sought to examine whether EHCS receive care services from the agencies and not the process of receiving care
Summary
The Japanese government has expanded its ‘Elderly Housing with Care Services’ (EHCS) to ensure sufficient places of death for the elderly, resident deaths have occurred in less than 30% of the facilities. Our purpose was to identify the factors associated with residents’ deaths in the EHCS, especially within the areas that are expected to have a large increase in the number of deaths. To ensure sufficient places of death, the government has covered end-of-life (EOL) care services that are provided by home care agencies (e.g. visiting nurse agencies) and aged care facilities (e.g. nursing homes) in the LongTerm Care (LTC) Insurance System. The number of EOL homecare service users is increasing, but it is still difficult for elderly individuals to die at home due to the existing shortage of family caregivers because of the Sugimoto et al BMC Palliative Care (2017) 16:58 decreasing birth rate. To ensure that enough beds are available, the government excludes mildly impaired elderly individuals from eligibility for admission to these facilities, but there are still a large number of people waiting for beds (295,000 in 2016) [6]
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