Abstract
BackgroundTo promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies.MethodsWe administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care.Results378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0–60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0–7) and CM agencies had 1.5 (SD = 2.2; range 0–18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p < 0.001) and a large number of collaborating CM agencies (OR: 1.08; p = 0.008) were positively associated with the provision of EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p < 0.001) was positively associated with the provision of EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care.ConclusionThe agency’s size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.
Highlights
To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process
Information concerning the number of clients who died at home was only present in the questionnaires from 371 (37.5 %) home-care nursing (HN) agencies, 274 (23.3 %) HH agencies, and 452 (38.3 %) care management (CM) agencies
The median numbers of professional staff were 4.0 for HN agencies, 6.1 for HH agencies, and 2.0 for CM agencies; the number of clients per month was largest for CM agencies, with median numbers of 58.0
Summary
It is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associ‐ ated with the provision of home-based EOL care cases, and to compare them among three different types of homecare agencies. It is necessary to clarify the factors related to conducting EOL care and to consider effective strategies to deal with the process. Since home-care agencies in Japan are generally managed on a small scale with a limited number of staff [6], it is not often possible to respond to urgent situations, which is critical for EOL care. In order to promote homebased EOL care, it is necessary to carefully examine the factors that enable or hinder EOL care in each type of agency and develop effective strategies for supporting them
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