Abstract
BackgroundTo develop a quality community-based care management system, it is important to identify the actual use of long-term care insurance (LTCI) services and the most frequent combinations of services. It is also important to determine the factors associated with the use of such combinations.MethodsThis study was conducted in 10 care management agencies in the urban area around Tokyo, Japan. The assessment and services data of 983 clients using the Minimum Data Set for Home Care were collected from the agencies. We categorized combination patterns of services from descriptive data analysis of service use and conducted chi-squared automatic interaction detection (CHAID) analysis to identify the primary variables determining the combinations of the services used.ResultsWe identified nine patterns of service use: day care only (16.5%); day care and assistive devices (14.4%); day care, home helper, and assistive devices (13.2%); home helper and assistive devices (11.8%); assistive devices only (10.9%); home helper only (8.7%); day care and home helper (7.7%); home helper, visiting nurse, and assistive devices (5.4%); and others (11.3%). The CHAID dendrogram illustrated the relative importance of significant independent variables in determining combination use; the most important variables in predicting combination use were certified care need level, living arrangements, cognitive function, and need for medical procedures. The characteristics of care managers and agencies were not associated with the combinations.ConclusionThis study clarified patterns of community-based service use in the LTCI system in Japan. The combinations of services were more related to the physical and psychosocial status of older adults than to the characteristics of agencies and care managers. Although we found no association between service use and the characteristics of agencies and care managers, further examination of possible bias in the use of services should be included in future studies. Researchers and policymakers can use these combinations identified in this study to categorize the use of community-based care service and measure the outcomes of care interventions.
Highlights
To develop a quality community-based care management system, it is important to identify the actual use of long-term care insurance (LTCI) services and the most frequent combinations of services
Services utilized in long-term care insurance We investigated the use of LTCI services by each client according to their care plan
The questionnaire was not completed by the care manager (CM) of one corporation because those CMs had a high amount of daily routine work
Summary
To develop a quality community-based care management system, it is important to identify the actual use of long-term care insurance (LTCI) services and the most frequent combinations of services. The rapidly aging society in Japan led to the introduction of mandatory public long-term care insurance (LTCI) in 2000. The goal of the LTCI was to develop a system of social care that would help older people live independently regardless of disability [1,2]. It covers long-term nursing care and social services for persons aged 65 years and over, as well as those between 40 and 64 years with specific age-related diseases [3]. Because of the increasing use of services, providing quality services has become even more important
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