End-of-life conversations: lessons from a Japanese care roundtable

In October 2023, the inaugural JS Festival brought hundreds of elderly-care practitioners, administrators, researchers, and suppliers to Tochigi Prefecture for three days of research presentations, hands-on workshops, study tours, and a sizeable exhibition of eldercare products. Among the most talked-about sessions was a networking roundtable focused specifically on end-of-life care discussions, where attendees swapped notes about how to start, sustain, and document those quiet but critical conversations with residents and families.

The roundtable format was deliberately informal. Small groups rotated through facilitated discussions, and facilitators encouraged participants to bring examples from their own facilities rather than polished case studies. What emerged was a snapshot of how end-of-life care is being approached in different parts of Japan, with implications that stretch well beyond the country where the meeting was held.

A regional conference with national reach

JS Festival was conceived as Japan's first national gathering dedicated specifically to welfare facility practice, rather than the broader aged-care conferences that had come before. Held across venues in Tochigi, the event drew delegates from Hokkaido in the north to Kyushu in the south, with a strong contingent of facility managers and care directors representing both large urban operators and smaller regional providers.

The programme reflected a hands-on philosophy. Research presentations sat alongside practical workshops on topics like nutrition, dementia communication, and fall prevention, while study tours took participants into local facilities to observe daily routines. An accompanying exhibition showcased everything from mobility aids and bathing systems to software platforms designed to streamline care documentation. Registration and accommodation bookings were handled through an external system, with the secretariat — reachable through the conference contact page — fielding enquiries about presentations, sponsorship, and travel logistics.

Why end-of-life conversations sit at the centre

Few topics in aged care carry the weight of a conversation about dying. Yet across the developed world, practitioners repeatedly report that these are the discussions most often deferred, delegated to the moment of acute illness, or avoided altogether. In Australia, the Royal Commission into Aged Care Quality and Safety heard repeated evidence about how poorly handled end-of-life conversations affected residents, with families sometimes learning about a relative's terminal prognosis only after a hospital transfer.

For Australian practitioners working in culturally and linguistically diverse communities — and many facilities in Sydney, Melbourne, and Brisbane serve residents from more than a dozen language backgrounds — the question of how to begin such a conversation is doubly fraught. Advance Care Planning Australia has long argued that the absence of a recorded plan is often less about refusal and more about timing, language, and trust. The JS Festival roundtable took that observation as a starting point rather than treating it as background.

What participants brought to the roundtable

Around thirty delegates sat at each rotation, with care directors, doctors, nurses, social workers, and care workers sharing a single table. The facilitators — drawn from university palliative-care research groups — used a simple prompt: describe one conversation that went well, and one that did not. Participants were also invited to bring printed care plans, advance directive templates, or family-meeting scripts they had found useful in their own work.

Common threads emerged quickly. Many Japanese participants spoke of family meetings as the key moment, often held with three generations present and frequently involving a decision about whether to continue artificial nutrition or move to palliative-only care. Others described how the introduction of a simple one-page conversation record had reduced repeated questioning by locum doctors. Several delegates had travelled specifically to learn how facilities in other prefectures were managing conversations with residents who had cognitive impairment, and the session generated visible energy whenever a participant described a small, practical change that had made a genuine difference.

Bridging Japanese practice and Australian realities

A number of parallels surfaced that translate directly to Australian facilities. The Japanese emphasis on collective family decision-making resonates with community expectations in many parts of regional Australia, where decisions about palliation are still made around a kitchen table with extended family gathered in for the arvo. The challenges of distance — flagged by several Tochigi-based participants whose facilities serve rural catchments — mirror the situation faced by aged-care homes across the Queensland outback, the Western Australian wheatbelt, or the long stretches of inland New South Wales.

Australian practitioners at the session also noted differences in regulatory framing. Where Japan's Long-Term Care Insurance scheme sets the broader policy context, Australia's Aged Care Quality Standards and the strengthened standards rolled out from late 2024 require explicit attention to clinical governance and to the way end-of-life wishes are documented. Speakers from Palliative Care Australia, contributing via video link, pointed out that national guidelines and on-the-ground practice often diverge, and that gatherings like the Tochigi roundtable help close that gap. Australian attendees left the session noting how rarely they get protected time to compare notes, and how valuable the Japanese facilitators' approach was in keeping things grounded in real cases rather than abstract theory. For those curious about the broader event, details and post-conference materials can be found at ChiliChillin's event portal.

Practical pathways for facility leaders

For practitioners planning their own internal roundtables or quality-improvement projects, the JS Festival experience suggests a handful of approaches worth borrowing. None require new funding, although they do require protected time — something Australian providers have found easier to argue for since the Royal Commission highlighted cases where poorly handled conversations caused lasting distress to families.

• Schedule a recurring monthly slot, even thirty minutes, where staff can debrief a recent end-of-life conversation without judgement and identify one thing to try differently next time.
• Use a single-page template for recording resident wishes, including space for cultural and spiritual preferences, and keep it at the front of the care file so it is visible during handover.
• Train at least two staff members in formal advance-care planning conversations, so that they can bring families into a familiar dialogue rather than passing the task to a stranger on the day.
• Build relationships with local palliative-care teams and specialist nurses before they are needed, rather than after a crisis has begun.
• Invite families to record a short video or written message that can be played to the resident when family cannot be present, especially for those in rural or remote settings.
• Review every end-of-life admission retrospectively as a team, looking at what worked and what could have been handled better, and document the lessons for the next family meeting.
• Translate key conversation prompts into the main community languages spoken by your residents, and have them reviewed by cultural advisors rather than relying on direct translation alone.

The lasting impression from Tochigi was that end-of-life care is, above all, a craft improved through conversation. Australian practitioners who took part left with renewed energy to build those quiet, regular opportunities for staff to learn from one another — and with a fresh sense that the questions being asked in Japanese facility boardrooms are recognisably the same ones being asked in Australian ones, from a small regional home in Toowoomba to a sizeable facility in Parramatta.