[Current status of relocation among terminally ill older residents of nursing facilities: Observational study using anonymous long-term care receipt information]

Objectives In Japan, efforts to provide "end-of-life care" in nursing homes are increasing and its introduction through long-term care insurance in 2006 is a major step forward. However, previous studies have shown that relocating older adults to their end-of-life care affects their burden. This study examined individuals' end-of-life care use under long-term care insurance in older care facilities and investigated the relocation frequency among terminally ill older residents of nursing facilities using receipt data.Methods The research targeted individuals aged ≥ 65 years under long-term care insurance who used formal end-of-life care services and were passed into residential facilities between April 1, 2018 and March 31, 2021. Data were obtained from anonymous long-term care certification information provided by the Ministry of Health, Labor, and Welfare. Six facilities providing end-of-life care were considered; older care facilities, geriatric health service facilities, designated establishments, and dementia group homes. A total of 233,735 individuals with service use records in the month of service cessation were aggregated according to facility, individual factors, and prefecture. Additionally, we defined end-of-life relocation as occurring if three categories of end-of-life care fees (day of death, 1-2 days before death, and 4-30 days before death) did not continue until the day of death.Results The participants were individuals aged ≥ 85 years (83.35%), 25.29% were men, and 93.53% required a care level of ≥ 3. Older nursing care facilities recorded the highest number (114,356) of end-of-life care users. The proportion of individuals with moderate-to-severe dementia (level ≥ IIIa; approximately 80%) was higher in nursing homes for older adults, community-based nursing homes for older adults, and dementia group homes than in other facilities. Relocation during the terminal phase was less prevalent in facilities with higher doctor and nurse staffing levels. At the individual level, relocation is more frequent among men, younger individuals, those with lower care levels, and those with intact decision-making and communication abilities. Conclusion Terminally ill residents aged ≥ 80 years with severe levels of care were the most likely to use end-of-life care. Moreover, 0.2-2% relocated across all facilities within 30 days before death. The relocation frequency increased based on individual factors and was mitigated by a thorough system of medical staff deployment.