Summary Introduction : In Japan, which has become aging society, there have been discussions in various forums have discussed how to deal with cases in which a patient has expressed ″do not attempt resuscitation″ order when a sudden change is anticipated, based on the premise of advance care planning. Against this background, an “Additional End-of-Life Care” has been formulated with the aim of assisting residents to meet their final days peacefully, but the actual situation is not yet clear.

Purpose : The purpose of this study is to examine the current status and problems of the additional end-of-life care program.

Methods : A questionnaire survey was conducted at 241 elderly care facilities in Sagamihara City located at the northern part of Kanagawa Prefecture, to determine whether end-of-life care differs depending on whether end-of-life care fees are calculated or not.

Conclusion : Although a high percentage of facilities in the “Calculated facilities” confirmed the residents intention in advance, many facilities transported the residents to emergency hospitals as in the “non-Calculated facilities “ in the event of a sudden change in condition, thus failing to fulfill the original purpose of the Additional end-of-life care.

　We report 2 patients with ischemic stroke from Trousseau’s syndrome during home-care, and 1 patient who started to receive home-care after 2 ischemic strokes from Trousseau’s syndrome.

Case 1 : A 38-year-old woman with lung adenocarcinoma had an ischemic stroke at home, and was transported to the hospital. Intravascular therapy and heparin infusion was done. She died of cancer at the hospital.

Case 2 : A 62-year-old man with renal pelvis carcinoma had an ischemic stroke at home, and was transported to the hospital. Heparin infusion was done, and he came back to his home. He died at home.

Case 3 : A 58-year-old woman had multiple ischemic strokes 2 years ago, and was diagnosed with ovarian cancer. Home-care was started after the recurrence of ischemic strokes. Gastrointestinal bleeding, the third and forth ischemic strokes, and convulsion were managed at home. After 3 months, she died at home.

　Even if the prognosis of cancer itself is short, it is necessary to react to a new stroke immediately, for better QOL by preventing recurrence of strokes and managing complications as possible.