Search for a command to run...
Objectives In Japan, the number of home-based cancer deaths has been increasing due to population aging. However, home-based end-of-life care among patients with terminal cancer are short-term, and the actual use of long-term care (LTC) insurance services remains unclear. This study aimed to elucidate the duration of home-based care and use of LTC insurance services before death among older adults with terminal cancer in Japan.Methods Using data extracted from the Japanese Long-term Care Database provided by the Ministry of Health, Labour and Welfare, we analyzed 16,865 insured individuals aged ≥65 years who were billed for the Terminal Care Management (TCM) add-on between April 2018 and March 2021. The observation period was set at 12 months preceding the month of death (the month in which the add-on was billed). Monthly data on the use of home care support and services were examined to determine the duration of home-based care and trends in service use antemortem.Results Of the participants, 57.5% were men, 40% were aged 75-84 years, and approximately 60% were cognitively independent. The national TCM billing rate among home-based cancer deaths in individuals aged ≥65 years was 12.4%, with substantial prefectural variation; Nagasaki and Yamanashi were >20%, whereas Akita, Niigata, and Tottori were <5%.The distribution of continuous home-based care antemortem was skewed toward shorter durations, with 26.2% of patients receiving care for ≤1 month and 52.8% receiving care for up to two months. In the month of death, the most frequently used LTC services were welfare-equipment-rental (97.1%), home-medical-care-management-guidance (59.3%), home-visit-care (38.2%), and home-visit-bathing (26.5%). Physicians and pharmacists predominantly provided guidance. The use of home-visit bathing increased sharply from two months antemortem.Conclusion The duration of home-based care among older adults with terminal cancer was short, with a median of <2 months (mode; 0.5 months), corresponding to the month of death. Key home care services, such as welfare-equipment-rental, home-medical-management-guidance, home-visit-care, and home-visit-bathing, were intensively used near the end of life. However, the use of the TCM add-on remained limited. These findings highlight the regional disparities and challenges in home care systems, underscoring the need for early support and care management to promote interdisciplinary collaboration.