Regional Supply of Nursing Home and Hospital Beds Determine Discharge Destination of Nursing Home Residents in Japan

Abstract

ObjectivesJapanese special nursing homes provide permanent residence to elderly people under the public long-term care insurance program. However, a quarter of discharges occur via death in hospital, and a fifth occur via admission to hospital. The objective was to identify factors associated with discharge destinations for residents of Japanese special nursing homes. DesignA retrospective design for data collected in 2007, 2010, and 2013. SettingWe used data from the Survey of Institutions and Establishments for Long-Term Care, which is a nationally representative cross-sectional survey that assessed discharge from special nursing homes in September every 3 years. ParticipantsThere were 2426 discharged residents included in the analysis. MeasurementsDischarge destination was categorized as death at facility, death in hospital, hospital admission, and another care setting. Multivariate multinomial logistic regression analysis was conducted with discharge destination as the dependent variable. ResultsOf the 2426 discharged residents included in the analysis, 874 (36.0%) were deceased at the facility, 773 (31.9%) were deceased in hospital, 652 (26.9%) were admitted to hospital, and 127 (5.2%) were admitted to another care setting. Residents of facilities in the regions with fewer nursing home beds or more hospital beds were more likely to be discharged via admittance to hospital or another care setting relative to being deceased at the facility. ConclusionThe regional supply of nursing home and hospital beds could have affected end-of-life care locations for residents of special nursing homes. To promote end-of-life care in special nursing homes, regional supply of nursing home beds should be reinforced while controlling oversupply of hospital beds.