Abstract
BackgroundThis population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for long-term care insurance (LTCI) benefits.MethodsHealth insurance data and LTCI data were combined into a database of 1,020 individuals in two farming communities in Hokkaido who were enrolled in Citizen's Health Insurance. They had not received long-term care services prior to April 1, 2000 and were newly certified as eligible for Long-Term Care Insurance benefits between April 1, 2000 and February 29, 2008. The analysis covered 565 subjects who had not been hospitalised or institutionalised at the time of first certification of LTCI benefits. The adjusted hazard ratios (HRs) of hospitalisation or institutionalisation or death after the initial certification were calculated using the Cox proportional hazard model. The predictors were age, sex, eligibility level, area of residence, income, year of initial certification and average monthly outpatient medical expenditures, in addition to average monthly total home and community-based services expenditures (analysis 1), the use or no use of each type of service (analysis 2), and average monthly expenditures for home-visit and day-care types of services, the use or no use of respite care, and the use or no use of rental services for assistive devices (analysis 3).ResultsUsers of home and community-based services were less likely than non-users to be hospitalised or institutionalised. Among the types of services, users of respite care (HR: 0.71, 95% confidence interval [CI]: 0.55-0.93) and rental services for assistive devices (HR: 0.70, 95% CI: 0.54-0.92) were less likely to be hospitalised or institutionalised than non-users. For those with relatively light needs, users of day care were also less likely to be hospitalised or institutionalized than non-users (HR: 0.77, 95% CI: 0.61-0.98).ConclusionsRespite care, rental services for assistive devices and day care are effective in preventing hospitalisation and institutionalisation. Our results suggest that home and community-based services contribute to the goal of the LTCI system of encouraging individuals certified as needing long-term care to live independently at home for as long as possible.
Highlights
This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for longterm care insurance (LTCI) benefits
Because the individuals analysed had been certified as being eligible for LTCI benefits, their average monthly outpatient medical expenditures were likely to be higher than that of the national level
In this study, the impact of home and community-based services on hospitalisation and institutionalisation of individuals certified as being eligible for LTCI benefits for the first time was analysed after adjusting for demographic variables and outpatient medical expenditures
Summary
This population-based retrospective cohort study aimed to clarify the impact of home and community-based services on the hospitalisation and institutionalisation of individuals certified as eligible for longterm care insurance (LTCI) benefits. LTCI, by making it easier for individuals certified as needing long-term care to use home and community-based services, aims to prevent decline of functional level and allow elderly people to live independently in their homes for as long as possible [5]. Hospitalisation is for providing medical services and institutionalisation is for providing long-term care services, for frail elderly it is difficult to distinguish between the two. This is especially the case in Japan, where admissions to hospitals are frequently made for social reasons–no family member to provide care or long waiting lists for nursing homes [6,7,8]
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