Home-visit nursing can reduce early readmissions and improve quality of life in older patients with heart failure (HF). In Japan, allocation of home-visit nursing often depends on Long-Term Care Insurance (LTCI) certification, which is determined primarily by functional status within budgets. This study examined whether LTCI certification is associated with the frequency of early home-visit nursing. We retrospectively analyzed 88 patients with HF who initiated home-visit nursing at a single agency between 2014 and 2024. The outcome was the number of visits within the initial 2 weeks comparing patients with and without LTCI. Negative binomial regression estimated incidence rate ratios (IRR), adjusting for age, sex, activities of daily living (ADL), physician-issued special direction, and eligibility under Separate Tables 7 and 8 of the medical insurance system. The median age was 86 years [IQR 82-90], and 74 patients (84.1%) were LTCI-certified. Cross-tabulation showed no significant association between LTCI certification and ADL level (χ² = 6.60, df = 3, P = .086). LTCI certification was associated with fewer visits (IRR = 0.67, 95% CI 0.49-0.91, P = .011). Compared with ADL “independent,” the “bed-bound” category received more visits (IRR = 1.99, 95% CI 1.28-3.10, P = .002). Physician-issued special direction was associated with higher visit frequency (IRR = 3.39, 95% CI 2.59-4.48, P < .001). These findings suggest that function-based, budget-capped frameworks may under-allocate nursing intensity for medically complex HF patients. Aligning visit planning with medical risk in the early post-discharge period may improve equity and care quality.

This study aimed to discuss the role of home-visit nurses in managing continuous catecholamine infusion in patients with heart failure by investigating the outcome of patients and the home-visit nursing intervention. We conducted a retrospective, case series study of eight patients with heart failure who underwent home-based continuous catecholamine infusion between April 2016 and March 2024. Data including the patients' demographics, the duration of continuous catecholamine infusion, the frequency of nursing and emergency nursing visits, and patients' endpoints were collected. The median age of the patients was 68.5 (interquartile range: 51.8-80.0) years and 75% were men. The most common diagnosis requiring home-based catecholamine infusion was dilated cardiomyopathy. The median duration of continuous catecholamine infusion in the patients was 58.0 days. The median frequency of nursing visits was 8.4 times each week. Forty-five emergency nursing visits occurred, and the most common reason for these visits was managing infusion device malfunctions. Among the patients, six died at home, one was hospitalized owing to fatal arrhythmia, and one withdrew from continuous catecholamine infusion. This study shows the complexities of providing home-based care for patients with heart failure requiring continuous catecholamine infusion. Most patients with heart failure were able to spend the rest of their lives at home, despite the challenges of managing such a treatment outside the hospital. Our findings indicate the need for early intervention, multidisciplinary collaboration, and the development of home care protocols to optimize treatment efficacy and the quality of life of these patients.

Accurate prognostic prediction is essential in end-of-life care, particularly in Japan, where cultural values emphasize the importance of being present at the time of death. However, tools that are both accurate and feasible for use in home settings remain limited. Home-visiting nurses are often the primary healthcare professionals most involved during the terminal phase, providing detailed observations through their nursing records. These records may offer valuable insights for prognostic prediction in home-based care. A retrospective analysis was conducted using nursing records from 71 patients who received care from the Nana-r Home-visit Nursing Station between April 2016 and December 2023. Data from the final month before death were analyzed, comprising 1,217 nursing records and 57,884 words of text data. Text mining with KH Coder was used to examine co-occurrence networks and analyze keyword patterns in relation to the number of days until death. The analysis identified themes such as excretion-related activities, distress symptoms, skin and oral health, and consciousness levels. Temporal patterns revealed that terms like "walking" and " eating" were more common earlier, while "consciousness," "breathing," and "urination" appeared closer to death, reflecting systemic decline. These findings suggest that nursing records, particularly their free-text descriptions, provide meaningful insights into the terminal phase. Integrating these observations with quantitative data may support the development of practical tools to improve care strategies for patients receiving end-of-life care in home settings.

Background The home-death rate is widely used in Japan as an indicator of community-based end-of-life care; however, this rate includes deaths without professional involvement. This study examines whether the home-death rate reflects medically attended home-based deaths across municipalities. Methods An ecological panel study was conducted using data from 1,741 municipalities obtained in 2017, 2020, and 2023 (5,222 municipality-year observations). National datasets from the Ministry of Health, Labor, and Welfare include data on medical institutions, home-visit nursing services, and clinic-certified home deaths. The dependent variable was the proportion of deaths occurring at home. Explanatory variables included home deaths certified by home-care support clinics and general clinics as well as deaths under home-visit nursing reimbursed by medical or long-term care insurance. Fixed-effects panel regression models with municipality and year effects were applied, using cluster-robust standard errors. Finally, correlations between the model residuals and prefectural rates of coroner-investigated deaths were examined to explore the influence of non-medical deaths. Results Home deaths certified by general clinics and deaths under medical-insurance-reimbursed visiting nursing were significantly associated with higher home-death rates (β=4.06, 95% confidence interval (95%CI), 1.28–6.85; β=31.75, 95%CI 8.14–55.37, respectively). The associations between home-care support clinics and long-term care insurance-reimbursed visiting nursing were not significant. No correlation was found between residuals and prefectural rates of coroner-investigated deaths (r=0.09, 95%CI, –0.20–0.37). Conclusions Japan’s home-death rate partly reflects medically attended home deaths, particularly those involving general clinics and medical-insurance-reimbursed visiting nursing. However, because this rate also includes deaths without professional care, it should be interpreted as a contextual rather than a quality indicator of end-of-life care and complemented by measures capturing care involvement and coordination.