Changes in home visit utilization during the COVID-19 pandemic: a multicenter cross-sectional web-based survey

Abstract

Objective Home care is one of the essential community health care services; thus, identifying changes of home care utilization before and during the COVID-19 pandemic would be useful for researchers and policymaker to reconsider the home care system, the support needed for home care staff, and the collaborative system with hospitals in the COVID-19 era. We conducted a multicenter cross-sectional web-based anonymous survey of the directors of home visit facilities in Japan in August 2021. Results A total of 33 participants from 37 facilities responded to the survey. The number of patients dying at home and newly requested home visits increased during the COVID-19 pandemic (74.2%, 71.0%). One possible reason was the restricted visitation of inpatient facilities (93.5%). The underlying disease that the largest number of participants perceived as having increased compared with before the COVID-19 pandemic was cancer (51.6%). There were no significant differences in being in a rural area or the number of doctors in perceived changes in home visit utilization. Our study indicated that the director of home visit facilities thought the number of patients dying at home and newly requested home visits had increased compared with before the COVID-19 pandemic.

Change in the Proportion of Death at Home during the COVID-19 Pandemic and Its Associated Factors in the Municipality Level: A Nationwide Study in Japan

“…Our finding of an increased proportion of home deaths during the COVID-19 pandemic is consistent with that of a previous study based on a questionnaire survey conducted in home-visit facilities (6) . While the current data do not allow analysis of the causes of these deaths, a significant increase in the proportion of home deaths directly caused by COVID-19 is unlikely, as COVID-19-related deaths account for only approximately 1% of all deaths in 2021 (26) .…”

“…While the current data do not allow analysis of the causes of these deaths, a significant increase in the proportion of home deaths directly caused by COVID-19 is unlikely, as COVID-19-related deaths account for only approximately 1% of all deaths in 2021 (26) . By contrast, as reported by previous studies, the shortage of hospital beds and changes in the preferred location for EOL care due to visitation restrictions in inpatient facilities likely played a substantial role (6) , (7) , (8) .…”

“…Under these circumstances, several studies have reported that the COVID-19 pandemic has changed the end-of-life (EOL) care in Japan (6) , (7) and in several countries worldwide (8) , (9) . A questionnaire survey administered to home-visit facilities showed that the number of patients dying at home and newly requesting home healthcare increased after the COVID-19 pandemic, particularly among those with cancer, respiratory disease, and dementia.…”

“…The main reasons for the increased demand for home-based EOL care were considered to be the shortage of available hospital beds, particularly in the palliative care unit, and restrictions on inpatient visitation. These factors have prevented patients from spending valuable time with their loved ones during their final days (6) , (7) , (8) .…”

Changes in the place of death before and during the COVID-19 pandemic in Japan

“…Thus, the shift in the PoD from hospital to home, recognized over the global outbreak of emerging infectious diseases, varied greatly by patient age and CoD. A multicenter web-based survey of the directors of home visit facilities in Japan has reported an increase in home visits for patients with cancer during the pandemic [ 16 ]. Additionally, a study using Japanese vital statistics data has reported an increase in excess deaths at home among patients with cancer since the early stages of the pandemic [ 17 ].…”