Characteristics of Home-Visit Nursing Agencies That Closed after the 2012 Fee Revision for Home-Visit Nursing Services: A Nationwide Panel Data Analysis in Japan.

Masayo Kashiwagi,Noriko Morioka

doi:10.3390/ijerph18189820

Abstract

Despite the 2012 fee revision raising fees for home-visit nursing services to increase their supply in Japan, 300 to 500 home-visit nursing agencies (VNA) are still being closed annually. This study aims to identify the regional and organizational characteristics of the VNAs that closed after the 2012 fee revision. A longitudinal observational study was conducted using nationwide panel data of VNAs from 2014 to 2017 (N = 6496). Multiple logistic regression models stratified by years of operation were used for the analysis. We identified 821 closed agencies (12.6%). In this study, many important factors related to VNA closures were found. In the less than three years group, there were regional factors (lower aging rate and larger number of clinics) and an organizational factor (higher proportion of users under 40 years of age). In the 3–14 years group, there was a regional factor (larger number of clinics) and organizational factors (smaller number of FTE nurses, smaller number of users per FTE nurse, and smaller number of medical care types that can be provided). In the over 15 years group, there was an organizational factor (smaller number of FTE nurses). The findings provide valuable insights for policymakers in avoiding VNA closures.

Highlights

57.1% of the closed visit nursing agencies (VNA) provided care management services within the same organization. They had a median of 3.2 full time equivalent (FTE) nurses
In the agencies operating for over 15 years, the organizational factors significantly associated with VNA closures were: a smaller number of FTE nurses (AOR: 0.848, 95%CI: 0.755–0.942) and having a provision system for emergency home-visits (AOR: 1.869, 95%CI: 1.023–3.571)
20 years have passed since the long-term care insurance system (LTCI)’s introduction, and the number of older nurses is increasing. These findings suggest that the aging nursing-workforce that supported many agencies even before the LTCI’s implementation may have affected the VNA closures

Summary

Introduction

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Aging populations and increasing demand for long-term care are globally recognized as important policy issues [1]. Japan has the world’s highest proportion of individuals aged 65 years or older. By 2019, 28.4% of Japan’s population had already reached 65 years of age [2]. The domestic demand for medical and nursing care is expected to increase in

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