This study was conducted to clarify the actual status of deaths at home in rural communities and factors that enable patients to die at home. From all over Japan, 123 towns and villages were selected and a questionnaire survey was conducted by mail. The response ratio was 31.7% and the number of respondents 767. The ratio of deaths at home during the three-year period from 1994 through 1996 was 29.0% on an average, ranging from 6.8% to 63.0%. In most of the areas with higher ratios of deaths at home, there were doctors willing to provide care to patients in their homes and well-organized nurse stations for home visits.
Heart diseases and cerebrovascular diseases each accounted for more than 20% of all deaths at home, and cancer 14.0% for men and 9.0% for women. As for the length of stay at home from the onset until death, 19.3% was within 24 hours (sudden death), 27.5% more than one year, 18.4% more three years, and 7.3% more than 5 years. The length of care at home rarely extended over a very long period.
Those who had access to more than three types of home medical care and welfare services (home visits by nurses, homemaking services by home health aides, etc.) accounted for a mere 32.0%, indicating that home care still means hardly anything more than care by family members.
Medical treatment had been received by 73.1% of the patients before death, and it was assumed that the minimum medical care to remove pains and sufferings such as oxygen inhalation (15.5%) and use of narcotics (7.2%) was being dispensed.
Care or dying at home is based on five basic elements of primary care Accessibility, Comprehensiveness, Coordination, Continuity and Accountability, and implementing those five elements will realize a desirable form of home care.