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After he was diagnosed with leukaemia in July, Japanese senior Katsuo Saito decided not to treat it and opted for palliative care. He had a hard time finding a bed at a hospice or hospital, so he spent most of his remaining weeks at home.

“There are about 20 people on the waiting lists,” Saito, 89, told Reuters from his fifth-floor apartment in Tokyo where he lived alone.

Many Japanese are reluctant to die at home because they feel hospitals are safer and they don’t want to burden family members with caring for them.

But dying at home may prove an acceptable option as hospital beds become ever scarcer in an ageing society where one in four are over 65 and health officials predict a shortfall of more than 470,000 hospital beds by 2030.

“I think it’s good to have a doctor supporting people who choose to spend their final days, and naturally face death, in a place they spent their days living,” said physician Yuu Yasui.

Yasui, who works at the Yamato Clinic, which has overseen more than 500 home deaths since 2013, hopes to offer hospice care at home for more of the terminally ill.

Mitsuru Niinuma, 69, chose to stay at home in order to spend more time with his grandson and his beloved dachshund, Rin.

“Home care allows people to use their abilities to their fullest for as long as possible,” he said. “That’s not so easy in a hospital. This aspect is really nice.”

Rising costs in Japan

Rising health care costs as the population ages have fuelled apprehension that Japan will eventually cap the number of hospital beds, although a health ministry official who declined to be identified called that scenario unlikely.

The bed shortage stems partly from long hospital stays, which ran 16.5 days on average in 2015, versus six days in Britain, a study by the Organisation for Economic Cooperation and Development (OECD) showed.

More than 80% of Japanese prefer to die in hospital, the highest figure among 35 nations surveyed by the OECD.

Leukaemia patient Saito finally found a hospice spot in September. Two days after he moved in, he died.

National insurance provides individual hospital rooms only in exceptional circumstances, so they are out of reach for those like pensioner Yasuhiro Sato, 75, a victim of terminal lung cancer.

“Somebody rich, like a politician or a singer, they solve everything through money. They can stay in private rooms,” Sato said in an interview at his Tokyo apartment in July.

With no close family or friends, he lived a solitary life, except for caregivers’ visits. When Sato died on Sept 13, the only other people in his apartment were doctors, aides and undertakers.

“It’s okay. I’m not a burden to anybody,” he said. “I will go to the afterlife quietly. Alone.” – Reuters/Megumi Lim/Kim Kyung-Hoon