ABSTRACT
<b>Introduction</b> : One of the key challenges in promotion of medical and nursing care collaboration in long term care is the difficulty in understanding the current state of acceptance of clients with high medical acuity by local long term care service providers. This study therefore aimed to clarify the current state and issues regarding such clients.<br><b>Methods</b> : Information was obtained via face to face interviews at 102 facilities out of 105 located in Area B in Prefecture A.<br><b>Results</b> : (1) Most of the facilities, except Long-Term Care Health Facilities, do not have night shift nurses, making it difficult for them to accept anyone who needs a medical procedure, such as tube feedings or sputum suctioning. <br>(2) The number of the facilities accepting elderly clients who require sputum suctioning decreased after the current regulations came into force, due to lack of human resources to provide the time off for training of the staff, and concern regarding costs of training and equipment given the current provider business environment. <br>(3) Lack of understanding by physicians appears to be the largest challenge with regards to end-of-life care, and is a larger factor than lack of understanding and experience of the facilities.<br><b>Conclusion</b> : Collaboration between medical and nursing care needs to be further enhanced based on clear understanding of roles and reality of the facilities.