Background Geriatric health services facilities (GHSF) play important roles as intermediary institutions by providing rehabilitation, nursing, and daily care services for elderly individuals prior to returning home from the hospital. However, the number of residents who spend their end of life in the facilities is increasing.

Aim To clarify current status of end-of-life care discussions (EOLD) in GHSF in Japan. We also analysed factors related to the facilities which provided EOLD prior to life threatening health deterioration.

Methods We conducted a nationwide cross-sectional survey by mailing questionnaires about end-of-life care and EOLD to 3437 managing directors of GHSF in 2012.

Results The response rate was 20.7% (n = 713), of which 521 (73.1%) provided discussion about end-of-life care. Among those 521 facilities, 304 (58.3%) conducted EOLD with residents and family members after life threatening health deterioration, whereas 199 (38.2%) held those prior to health deterioration. Several factors were statistically significant for introduction of EOLD before health deterioration including education of EOLD for care workers and nurses, availability of doctors in emergencies, private rooms provided for critically ill residents, and accumulated experience based on the average number of residents who died while receiving care at the facility.

Discussion/conclusion This is the first nation-wide survey regarding EOLD in GHSF in Japan. Adequate practical staff education program of end-of-life care and EOLD may be crucial for quality end-of-life care in GHSF in Japan.