Abstract
In order to compare the quality of care by the site of death, the Toolkit questionnaire, consisting of items such as response to pain, appropriateness of physician's communication and overall satisfaction, was mailed to the deceased's family from all five hospitals within a city and from 92 of the 653 randomly selected national sample of nursing homes agreeing to participate in our study. Valid responses were received from 205 (48.0%) in the hospital group, and from 256 (63.2%) in the nursing home group, of which 163 had died within the facility and 93 had been transferred to hospitals. Deceased family members of those who had died within the nursing home evaluated the care as being better when compared with those in the hospital group for most items. When compared with the United States, results varied by each item in the hospital groups, but for those who had died in nursing homes, Japan had better quality in virtually all items, with the exception of overall satisfaction. Next, the results were compared for patients who had required ADL assistance for one or more years in the hospital group, residents who had been transferred to hospitals in nursing homes, and residents who had died within the facility. The family rated the quality of the residents who had died within the nursing home as being the best. More attention should be focused on the quality of end-of-life care than on the site of death.
