5. Conclusion
Since the government decided to expand EOL care in
nursing homes, the percentage dying in nursing homes has
increased from 28.6% in 2002 to 47.4% in 2009. The facility
variables related to a higher proportion dying in nursing
homes were the physician being based in designated home
care supporting clinics and the facility’s policy to provide
EOL care. The resident variables were pneumonia not being
the cause of death, family’s preference and agreement
among family members on the nursing home as the siteof death. However, being a designated EOL care facility,
which is the condition to bill for the EOL bonus, was not
significant after adjusting for facility and resident variables.
Few received or did not receive LST despite their preference
but these proportions were higher among those who died
in hospitals. If the government wishes to further increase
the proportion of the nursing home as a site of death, the
focus should be on the quality, and not just the presence
of nurses, and on redefining the function of nursing homes
from that of a social welfare organization providing an asylum
for low income elders to that of providing EOL care to
those who prefer not to receive aggressive treatment.
Acknowledgements
Japan’s Ministry of Health, Labour and Welfare provided
funds from the Project on Promoting Elderly Health. We
thank Professor Vince Mor of Brown University for providing
data from US nursing homes and Professor Emeritus
John Creighton Campbell of the University of Michigan for
his insightful comments.