The purposes of this study were to (1) to identify the viewpoints of bereaved families about their evaluation of end-of-life care for a family member at a nursing home, and (2) examine end-of-life care for residents and their families. We conducted semi-structured interviews with 17 bereaved families of residents who had passed away at three nursing homes. We analyzed the data using a qualitative approach and conventional procedures of content analysis. Six core categories were identified. Two core categories emerged for the residents, about what bereaved families believed to be beneficial: "painlessness, physical comfort, and spiritual well-being" and "care that involves respect for the resident." Two core categories emerged for the families: "readiness for resident's death and presence during the death" and "respect for the needs of the family." Family members experienced emotional suffering when residents received care that they believed was not beneficial. The results of this study suggest that it is important to provide care for residents that prevent physical suffering due to dehydration, optimizes comfort both physically and spiritually, and display a respectful attitude for preserving their dignity. It is also important to ensure that family members are present during the resident's death by predicting the death period and confirm mutual agreement between family members and staff.

The aims of this study were to investigate the factors related to physical restraint use in long-term care facilities (nursing homes and long-term care health facilities) and to compare physical restraint prevalence among the prefectures of Japan using nationwide administrative data. We obtained data regarding long-term care facilities in 2017. To compare the characteristics between facilities with and without physical restraint use, chi-square tests and t-tests were conducted.

We determined 6535 nursing homes and 3643 long-term care health facilities to be eligible; of these, 66.4% and 50.3% used physical restraint for the residents, respectively. The percentage of categories ownership was significantly different between the facilities with/without physical restraint. Both in nursing homes and long-term care health facilities, the facilities that used physical restraint were less likely to have manuals (p<0.001) and training programs about the prevention of physical restraint for employees (p<0.001). Among the nursing homes, the years of experience of nursing staff were significantly lower in facilities without physical restraint use than those in facilities with physical restraint use. The prevalence of physical restraint use differed among the prefectures and the prefectures with regional government policies were less likely to use physical restraint. Our findings suggest that both facilities based and regional government were important.