Factors related to a sense of security with medical and long-term care services among community-dwelling middle-aged and older adults in Japan.

Introduction: Japan has the highest elderly rate of population in the world. In 2012, the government implemented the community-based integrated care system, which integrates various health-related resources within the community through cooperation among formal, long-term care facilities, welfare and medical care specialists, and informal voluntary activities by the residents. The system was first born in a rural town in Hiroshima.Description of the policy: This presentation shows how a trial in a typical rural town achieved the community-based integrated care system, influenced the governmental policies, and became the first model for the subsequent nationwide reform of healthcare system. In 1970s, the aging population has been prominent in Mitsugi. At that time, care for the elderly was fragmented into various service sections. An integrated care system marshaling all services and providing an integrated delivery system, which was later called the community-based integrated care system, has been gradually constructed in Mitsugi as follows.Firstly, in 1970s, the hospital started providing home-visit services; doctors, nurses, long-term care workers and the like would visit patients’ houses, support their life at home instead of patients coming to the hospital. It promoted linkage between care services in the hospital and at home. Secondly, the Health Management Center was opened as an annex of the hospital in 1984. This center involved some departments of the municipal government, which had been responsible for the preventive, welfare and long-term care services in those days. It enabled the hospital to play a role in not only medical but also preventive, welfare and long-term care services, which facilitated providing these services seamlessly. Thirdly, long-term care facilities such as a nursing home and a group home for demented elderly patients were established. These facilities made long-term care possible for the elderly people that cannot be cared for at home. Lastly, Mitsugi launched volunteers’ action by community citizens to help the elderly with the cooperation of the hospital. This volunteer system has formed the connection between residents and the hospital, which has made more seamless community-cooperative comprehensive care possible.Results: After the system, the proportion of bedridden people decreased remarkably from 3.5 to 1% in this town. In addition, this system realized slowing growth of healthcare costs, while they were then rapidly increasing throughout the rest of Japan. Although healthcare costs for elderly in Mitsugi were above average in Hiroshima prefecture until about 1985, the status has since been reversed, maintaining a lower level than the prefectural mean. After its success, the first community-based integrated care system case in Mitsugi became the model for the national policy implemented in 2012.Highlights: Success in a small rural town can influence the entire country. This is the first case of diffusion of a healthcare system from rural to urban areas, which is unusual. The reasons why the first community-based integrated care system arose in Mitsugi are the aging of the population, easy integration of services due to its small size, the economic support from the prefecture, and existence of a leader that coordinated different sectors of healthcare.Conclusion: There are three future tasks to sustain the community-based integrated care system. Firstly, the system suitable for each community should be constructed. Secondly, vigorous resident participation is needed in this system so that they can find and introduce neighbors that need medical or long-term care services to the system. Finally, finding ways to reduce the costs for medical and long-term care services at a nationwide level.

AimTo determine the impact of increased copayment on long-term care (LTC) and medical service utilization among older adults in Japan. MethodsLTC and medical claims data were obtained for individuals aged 75 years as of August 1, 2014, and those utilizing LTC services in Fukuoka Prefecture, Japan, between August 2014 and March 2019.Participants were categorized into three groups: the 10% group (no copayment change), the 20% group (copayment increased from 10% to 20% in August 2015), and the 30% group (copayment increased from 20% to 30% in August 2018).Monthly panel data was constructed , and controlled interrupted time series analysis was used to estimate changes in LTC and medical expenditures before and after the copayment increases. ResultsOf 32,295 participants, 2991, 1459, and 925 were in the 10%, 20%, and 30% groups, respectively.LTC expenditure increased significantly by an average of 502.5 yen per month during the 12 months before the first intervention, with a further significant increase of 560.0 yen between the two intervention periods.The 30% group had a significant decrease (569.9 yen/month) in facility service expenditures and a significant increase (996.5 yen/month) in hospitalization expenditures after the second intervention. ConclusionsNo clear reduction in LTC expenditure was observed, suggesting a possible shift from LTC to medical care.Further research is needed to examine measures, including copayments, for the appropriate medical care and LTC service use.

Impact of COVID-19 on Long-Term Care Service Utilization of Older Home-Dwelling Adults in Japan

This study aimed to determine whether there are disparities in the utilization of home-based care services according to income level among people aged 75 years or older in Japan. The research team used administrative claims data from April 2014 to March 2018 for people aged 75 years or older in Fukuoka Prefecture. Subjects were categorized according to income level using medical insurance claim data. Associations between income level and usage days of inpatient care, outpatient care, home medical care, and usage number of home-based long-term care (LTC) services were evaluated. Furthermore, medical and LTC costs were evaluated and adjusted for gender, age, and level of LTC needs. The team used generalized linear models (GLMs) to estimate medical and LTC services utilization, as well as the potential influence of gender, age, care needs level, and death as risk factors. The study analyzed 31,322 subjects, among whom 17,288 were in low-, 12,755 were in middle-, and 1399 were in high-income groups. The results of GLMs showed the number of home medical care days was 59.45, 62.24, and 69.66 days for users from low-, middle-, and high-income groups, respectively. Correspondingly, the number of home-based LTC services used was 668.84, 709.59, and 833.14 times. This study suggests that older adults with lower incomes had relatively low utilizations of home-based care services and high utilizations of nonhome-based LTC services. Policymakers should implement policies focused on people who need care to tackle socioeconomic inequalities in home-based care.

To investigate the factors associated with introducing visiting-pharmacist services for community-dwelling older adults in Japan. We conducted a nested case-control study using claims data in a cohort from a city in Tokyo. Patients aged ≥65 years who received visiting-pharmacist services for the first time between April 2014 and March 2020 were considered case patients. A maximum of four controls to each case patient were randomly selected on the basis of sex, age, health insurance systems, and month-year. Medical and long-term care service usage and patient condition were assessed using claims data from the index and preceding months, along with long-term care needs certification data. Multivariable conditional logistic regression analysis was conducted to estimate the adjusted odds ratios with 95% confidence intervals for factors associated with visiting-pharmacist service introduction. A total of 22 949 participants (4591 cases and 18 358 controls) were included, with a median age of 85 years; 59.3% were women. The adjusted odds ratios (95% confidence intervals) of the three most related factors were 27.61 (23.98-31.80) for physicians' home visits, 5.83 (5.08-6.70) for hospitalization, and 4.97 (4.16-5.95) for designated-facility admission. Factors such as prescribing ≧10 medications, visiting nursing, and cancer were positively associated. In contrast, low household income and a high need for support due to cognitive function or disability were negatively associated. This study provides insights into the introduction of visiting-pharmacist services for older adults in Japan. Geriatr Gerontol Int 2024; 24: 344-351.

With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.

Effects of cost sharing on long-term care service utilization among home-dwelling older adults in Japan

Acceptance of care technologies to support activities of daily living by middle-aged and older adults in Japan: A cross-sectional study.

<p>隨著臺灣逐漸步入超高齡社會，重病或行動不便導致就醫不便的民眾正逐漸增加，居家醫療的需求也隨之而起。中醫於2019年納入「全民健康保險居家醫療照護整合計劃」，中醫師加入居家醫療照護及中西醫療整合，共同提升醫療服務與品質。2020年衛生福利部（以下簡稱衛福部）實施「建立中醫社區醫療及長期照顧服務網絡計畫」，從社區醫療、居家個案及長照服務發現需求，提供適切的資源。另由中醫師公會全國聯合會執行來自衛福部長照司核定的「一般及複雜照顧問題生活調養解決方案之專業指導」試辦計畫，透過跨專業之照顧，提高高齡者主動參與日常生活活動能力，解決困難照顧問題。本文將從人口老化與照護負擔至中醫在長照中所扮演的角色，分享中醫參與社區醫療及長照服務之經驗，希冀更多中醫師能夠參與，共創全民健康福祉。</p> <p> </p><p>As Taiwan enters the superaged society, the number of people who find it difficult to seek medical care because of severe illness or mobility problems is increasing, leading to a rise in the need for home medical care. In 2019, traditional Chinese medicine (TCM) was incorporated into the National Health Insurance Home Medical Care Integration Program; thus, TCM practitioners joined home medical care, leading to the integration of TCM and Western medicine, improving the quality of medical services. In 2020, the Ministry of Health and Welfare implemented the Program to Establish a TCM Community and Long-term Medical Care Service Network, in which the medical needs of people are identified through community, home, and long-term medical services and appropriate resources are provided accordingly. In addition, the National Union of Chinese Medical Doctor’s Association executed the pilot program Professional Guidance on Solutions for General and Complex Problems in Medical Care by the Ministry of Health and Welfare Department of Long-term Care, in which interdisciplinary care is provided to raise older adults’ capability to autonomously participate in daily life activities, thereby solving the difficulties encountered in medical care. In this study, the experience of TCM practitioners in participating in community and long-term medical care services is presented from the perspectives of population aging, burden of medical care, and the role of TCM practitioners in long-term care, providing incentives to TCM practitioners to participate in community and long-term medical care, thereby enhancing health and welfare across Taiwan.</p> <p> </p>

Setting standards in residential aged care: identifying achievable benchmarks of care for long-term aged care services.

As the significance of long-term care services for older adults becomes more pronounced in Taiwan, especially considering the intensifying trend of an aging population, there remains a lack of comprehensive attention to the long-term care needs and experiences of older adult individuals within the LGBTQ+ community. The present study examines the long-term care service awareness, needs, and usage intention of older adult male homosexuals in Taiwan and assesses their ideal long-term care service model. This study of five older adult male homosexual subjects aged 66 to 73 years is intended as a preliminary exploration. Interviews were used to collect data. The study determined that the five subjects displayed high awareness of long-term care services, as they possessed actual experience of these services or had even participated in care service staff training to obtain certificates. Some even had experience in applying for home care services and reported problems during use. The subjects perceived that they were very likely to require long-term care services in the future and tended to opt for home care services if they required long-term support. Due to their personal experiences, the subjects displayed negative awareness of long-term care services and expressed worry that long-term care service staff harbored poor attitudes toward homosexuals. The subjects considered the most important aspects of long-term care to be basic medical care and lifestyle care. However, they worried that long-term care staff would delay or refuse to provide such services due to the subjects’ sexual orientation or stereotypes related to it, and they were concerned above all about the “friendly attitude” of long-term care staff. They hoped that long-term care staff were friendly toward homosexuals and did not discriminate against them, feeling that it would be more appropriate for homosexual long-term care staff to provide assistance. In terms of vision, while preferring organizations with homosexual employees, the subjects worried that they would be stigmatized and discriminated against. Regarding ideal long-term care services, while considering institutions with homosexual staff to be ideal, the subjects also worried that these would be labeled as institutions that were dedicated to homosexuals, potentially resulting in discrimination. Therefore, they hoped that the sexuality sensitivity of long-term care staff could be improved and that they would undergo professional continuing education to learn about homosexuals, their situations, and care needs.

A Case for Community and Hospital-Based Long-Term Care Facilities in Saudi Arabia

This study examined predictors of older adults' and primary caregivers' willingness to use formal long-term care (LTC) services to understand possible use patterns of mandatory public LTC insurance programs in Korea. It focused on views regarding who (adult children or the government) should bear the responsibility for older adults' care. Logistic regression models were estimated using data from 1,168 older Korean adults aged 65 or older and their primary caregivers from a national survey. The results showed that older adults' and their caregivers' views on care responsibility were a dominant predictor of their willingness to use both formal home care services and nursing home care services. Both older adults and their family caregivers' willingness to use LTC services should be considered when predicting demand for LTC services. Efforts should promote the perspective that formal LTC services are an acceptable social norm.

No AccessMar 2023Community-Based Integrated Care in JapanAuthors/Editors: Japan International Cooperation Agency (JICA), Risa Nakayama, Xiaohui HouJapan International Cooperation Agency (JICA)Search for more papers by this author, Risa NakayamaSearch for more papers by this author, Xiaohui HouSearch for more papers by this authorhttps://doi.org/10.1596/978-1-4648-1958-2_ch7AboutView ChaptersPDF (0.8 MB) ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinked In Abstract: Offers an extended case study of Japan’s Community-Based Integrated Care System (CICS) for older adults, which aims to provide integrated care in the community to maintain the dignity of older people and support their independence. The roots of the CICS reach back several decades , and it has seen progressive integration into national legislation, insurance, and care delivery. CICS core principles include (1) collaborating to optimize regional resources; (2) enhancing self-support and mutual support among older adults and across the community; (3) enabling dignified lives; and (4) adapting to local contexts. Three detailed local examples showcase important CICS operational features, including integrated medical care, long-term care, and comprehensive living-support services. The CICS experience may hold lessons for developing countries, including the importance of designing comprehensive older adult care policies and programs from a long-term perspective not restricted to medical care. Some developing countries have distinctive strengths for this approach, including traditions of community solidarity and mutual support. Previous chapterNext chapter FiguresreferencesRecommendeddetails View Published: March 2023ISBN: 978-1-4648-1958-2e-ISBN: 978-1-4648-1965-0 Copyright & Permissions Related CountriesJapanRelated TopicsCommunities & Human SettlementsGovernanceHealth Nutrition and Population KeywordsCASE STUDYAGING POPULATIONACCESS TO HEALTH SERVICESHEALTH POLICYHEALTH CARE REFORMHEALTH OUTCOMESQUALITY OF HEALTH CARECOMMUNITY INVOLVEMENTCOMMUNITY-BASED CAREREGIONAL INTEGRATIONREGIONAL PLANNINGLONG-TERM CAREBEST PRACTICES PDF DownloadLoading ...

BackgroundLong-term care services for older adults are characterised by increasing needs and scarce resources. Political strategies have led to the reorganisation of long-term care services, with an increased focus on “ageing in place” and efficient use of resources. There is currently limited research on the processes by which resource allocation decisions are made by service allocators of long-term care services for older adults. The aim of this study is to explore how three political principles for priority setting in long-term care, resource, severity and benefit, are expressed in service allocation to older adults.MethodsThis qualitative study uses data from semi-structured individual interviews, focus groups and observations of service allocators who assess needs and assign long-term care services to older adults in Norway. The data were supplemented with individual decision letters from the allocation office, granting or denying long-term care services. The data were analysed using reflexive thematic analysis.ResultsThe allocators drew on all three principles for priority setting when assessing older adults’ long-term care needs and allocating services. We found that the three principles pushed in different directions in the allocation process. We identified six themes related to service allocators’ expression of the principles: (1) lowest effective level of care as a criterion for service allocation (resource), (2) blanket allocation of low-cost care services (resource), (3) severity of medical and rehabilitation needs (severity), (4) severity of care needs (severity), (5) benefit of generous service allocation (benefit) and (6) benefit of avoiding services (benefit).ConclusionsThe expressions of the three political principles for priority setting in long-term care allocation are in accordance with broader political trends and discourses regarding “ageing in place”, active ageing, an investment ideology, and prioritising those who are “worse off”. Increasing attention to the rehabilitation potential of older adults and expectations that they will take care of themselves increase the risk of not meeting frail older adults’ care needs. Additionally, difficulties in defining the severity of older adults’ complex needs lead to debates regarding “worse off” versus potentiality in future long-term care services allocation.Trial registrationNot applicable.