4. Discussion
Our study is the first to have analyzed changes that
have occurred since the introduction of the EOL care bonus
in 2006. The facility and resident characteristics of our
study were essentially the same as those of the national
survey [14]. When compared with the 2002 survey, the
facility and resident characteristics that were associated
with dying in nursing homes were basically the same.
However, there were also major differences: the proportion
of facilities having an EOL care policy of transferring
the resident to a hospital decreased from 58.5% to 35.6%,
while the proportion of residents who had died within
the nursing home increased from 28.6% to 44.9%. Thus,the government’s policy of encouraging more EOL care in
nursing homes appears to have had the desired impact.
However, we were not able to confirm whether this
change could be directly attributed to the introduction of
the EOL care bonus. Being designated as an EOL care facility
was not significant after adjusting for other variables. This
is not surprising because less than half of the designated
EOL care facilities had a general policy of providing EOL
care. While the proportion having such policy was nearly
three times the level of those not designated (38.3% versus
14.5%), becoming designated was not a sufficient condition.
However, the introduction of the bonus may have led
to more facilities adopting a policy of providing EOL. This
change in the nursing homes’ policy was probably the main
reason why the proportion of families preferring the nursing
home as the site of death increased from 44.5% in 2006
to 55.6% in 2009, while those preferring hospitals decreased
from 21.7% to 16.0%, rather than to inherent changes in
their preferences.
4. Discussion
Our study is the first to have analyzed changes that
have occurred since the introduction of the EOL care bonus
in 2006. The facility and resident characteristics of our
study were essentially the same as those of the national
survey [14]. When compared with the 2002 survey, the
facility and resident characteristics that were associated
with dying in nursing homes were basically the same.
However, there were also major differences: the proportion
of facilities having an EOL care policy of transferring
the resident to a hospital decreased from 58.5% to 35.6%,
while the proportion of residents who had died within
the nursing home increased from 28.6% to 44.9%. Thus,the government’s policy of encouraging more EOL care in
nursing homes appears to have had the desired impact.
However, we were not able to confirm whether this
change could be directly attributed to the introduction of
the EOL care bonus. Being designated as an EOL care facility
was not significant after adjusting for other variables. This
is not surprising because less than half of the designated
EOL care facilities had a general policy of providing EOL
care. While the proportion having such policy was nearly
three times the level of those not designated (38.3% versus
14.5%), becoming designated was not a sufficient condition.
However, the introduction of the bonus may have led
to more facilities adopting a policy of providing EOL. This
change in the nursing homes’ policy was probably the main
reason why the proportion of families preferring the nursing
home as the site of death increased from 44.5% in 2006
to 55.6% in 2009, while those preferring hospitals decreased
from 21.7% to 16.0%, rather than to inherent changes in
their preferences.
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4. Discussion
Our study is the first to have analyzed changes that
have occurred since the introduction of the EOL care bonus
in 2006. The facility and resident characteristics of our
study were essentially the same as those of the national
survey [14]. When compared with the 2002 survey, the
facility and resident characteristics that were associated
with dying in nursing homes were basically the same.
However, there were also major differences: the proportion
of facilities having an EOL care policy of transferring
the resident to a hospital decreased from 58.5% to 35.6%,
while the proportion of residents who had died within
the nursing home increased from 28.6% to 44.9%. Thus,the government’s policy of encouraging more EOL care in
nursing homes appears to have had the desired impact.
However, we were not able to confirm whether this
change could be directly attributed to the introduction of
the EOL care bonus. Being designated as an EOL care facility
was not significant after adjusting for other variables. This
is not surprising because less than half of the designated
EOL care facilities had a general policy of providing EOL
care. While the proportion having such policy was nearly
three times the level of those not designated (38.3% versus
14.5%), becoming designated was not a sufficient condition.
However, the introduction of the bonus may have led
to more facilities adopting a policy of providing EOL. This
change in the nursing homes’ policy was probably the main
reason why the proportion of families preferring the nursing
home as the site of death increased from 44.5% in 2006
to 55.6% in 2009, while those preferring hospitals decreased
from 21.7% to 16.0%, rather than to inherent changes in
their preferences.
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