Difficulties and Challenges for Collaboration Between Long-Term Care Facilities and Hospitals as Perceived by Nursing Managers at special elderly nursing home : Focus on the End-of-Life Medical Treatment and Care Decision-Making Process for Residents Given a Terminal Diagnosis

Abstract

In the process of determining policies for end-of-life medical treatment and care for cases in which residents of designated facilities covered by public aid providing long-term care to the elderly / special elderly nursing homes (hereinafter, “nursing homes”) are given a terminal diagnosis after hospitalization at a medical institution, this study clarified the difficulties and challenges associated with collaborations between long-term care facilities and hospitals, as perceived by nursing managers at nursing homes. In 2014, a questionnaire was mailed to 354 nursing managers at nursing homes across Japan. The percentage of respondents perceiving difficulties and challenges towards non-affiliated hospitals was significantly larger than those towards affiliated hospitals. In terms of difficulties, concerns about medical treatment (45.5%) were most common, followed closely by cooperation with attending physicians (43.8%). In terms of challenges, differences in understanding of nursing homes (79.7%) and the adverse effects of medical dependency (71.8%) each accounted for almost 80% of responses, suggesting the need for initiatives at medical institutions to encourage an understanding of the realities of nursing homes.