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Historical Changes in Home Care Service and Its Future Challenges.

The pressing changes to Japan’s medical care delivery system as the population ages has been bringing attention to home care. As Japanese society ages, the elderly made up 23.1% of the population in 2010, the highest in the world, and this rate is expected to increase further. In these conditions, when we look at trends in the place of death in Japan, we find that the percentage of people who died at home was over 80% around 1950, while the percentage of hospital deaths was over 10%, but this trend has reversed since 1976, with 78.5% of deaths taking place in a hospital in 2011 and 12.5% at home. 
 
The spread of medical technology previously only available in hospitals, such as artificial respirators, likely played a large part in this. This has resulted in a fact that very few people have the chance to experience a natural death in their own surroundings without using such an edging-cut device. At present, we rely on hospitals for end-of-life care and terminal care, but future estimates of terminal care locations suggests that even if the number of home deaths increases by about 1.5 times the current level, in 2030 about 470,000 people will not have a place for end-of-life care because of the limited capacity of the hospitals and nursing care facilities. 
 
In a questionnaire asking respondents where they want to receive end-of-life care, about 60% said that they wanted to be treated at home for as long as possible, but many people also worried about burdening their families and about how sudden changes in their symptoms would be handled. 
 
Indeed, in a patient survey carried out in October 2011, 110,700 people nationwide are expected to receive home care from either hospitals or clinics (visiting care or home visits by a doctor), but of these, 67,200 received visiting care, which is not very high. In order to deliver stable home care, a home care delivery system provided through inter-professional collaboration must be developed in collaboration with the hospitals that will be taking in emergency patients.