Collaboration Between Medical Staffs and Care Workers to Support Older Adults' End-of-Life Care at Home: A Case Study of the Daily Interactions Between Them in Service-Added Housing Facilities in Japan

Since approximately 40 years, end-of-life care in Japan is being managed mainly in medical institutions like hospitals or clinics. Recently, with an increasing trend in older adult mortality, provision of end-of-life care at home is being encouraged. Previous studies have pointed out that the collaboration between medical staffs (e.g., visiting doctor or home-visiting nurse) and care workers (e.g., in-home long-term care manager or home care worker) was necessary to support older adults’ end-of-life at home. However, few studies describe how these professionals interact with each other in the daily support activities, and how the dynamic processes of end-of-life care progress through the interactions between them, especially from the care workers’ perspective. To facilitate collaboration between them, this study aimed to reveal the nature of the same between medical staffs and care workers to support older adults’ end-of-life care at home, through a case study of the practices in service-added housing facilities for older adults, which is a noteworthy new housing facility in Japan. A door-to-door or phone survey was conducted in 12 service-added housing facilities in which end-of-life care was provided to three or more residents. Thus, 22 cases of home-based end-of-life care were identified. Through the analysis of the support processes recorded in the cases, the following key results and conclusions were revealed: Collaboration between medical staffs and care workers during end-of-life care had 2 aspects. 1) Each group helped the other to provide their services (e.g., if the medical staff noticed the change in an older adult’s condition, he/she informed the care workers the same, to help them modify their services accordingly). 2) Through their interactions, medical staffs and care workers interpreted and reformatted the changes in the older adults’ condition (e.g. edema) during end-of-life care as the ‘processes of end-of-life’ .