Place of Death and Density of Homecare Resources: A Nationwide Study in Japan

BACKGROUND: Although more than half of the population of Japan wants to spend their last days at home, approximately only 10% are able to do so. This study examined the associations between death at home and healthcare facility density by municipality based on the analysis of nationwide observed data in Japan. METHODS: We used data on deaths at home and healthcare resources in municipalities across Japan for the fiscal years 2014 and 2017. The proportions of deaths at home by municipality were used as the dependent variable, while healthcare resources (e.g., hospital density) divided by the population of older people in each municipality and municipality-level income were used as independent variables. We applied a fixed-effects regression analysis to examine the association of healthcare resources and municipality-level income with death at home. RESULTS: Clinics providing home medical care and facilities providing visiting nursing services were positively associated with death at home, with coefficients (95% confidence intervals) of 2.14 (1.12 to 3.15) and 2.19 (0.99 to 3.39), respectively. Stratified analysis showed that these associations were observed in higher income-level municipalities but not in lower income-level municipalities. CONCLUSION: Municipalities with a higher density of home care services had higher rates of death at home, whereas municipalities with a higher density of hospitals had lower rates. We recommend the development of policy that allows hospitals to be converted into home care providers so that more people can spend time in peace at home at the end of their lives.