[The problems of nursing and medical expenses in end-stage home therapy]

Recently, many end-stage patients and their families desire home care in their last days, because Japanese tend to think "quality of life" is the most important thing in their life. Home therapy for end-stage patients has become popular with the support of the government. The cooperation between medical staff and patients has overcome many problems derived from this new therapy system. Problems related to the person who looks after the patient, however, remain to be solved. Ninety-four home therapy cases of end-stage cancer have been treated as a private clinic experience since 1994. Although the medical expenses for home therapy are greater than for hospital treatment under the Japanese medical insurance system, the nursing fees for the person who looks after the patient are not considered enough. A heavy burden, not only by the nursing but also by their own occupation, has been imposed upon the nursing person. Differences in the expenses between home therapy and hospital treatment, and also the situation of the nursing person in the home therapy are reported in this paper.