Abstract
BackgroundWith the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.MethodsThe participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.ResultsIn the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.ConclusionThere were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.
Highlights
With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly
Home care services included home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, medical management by a physician and the number of types of services used during the 11 months
In the lower care needs level subgroup, the D group used significantly more respite stay in a nursing home (48% vs. 20%, p < 0.001), nursing home daycare (79% vs. 67%, p = 0.029), and respite stay in sanatorium-type medical care facilities (2% vs. 0%, p = 0.031) and a greater number of types of care services during the 11 months (p < 0.001) than the SI group (Table 2)
Summary
With the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. As a result of aging populations, the number of disabled elderly has become a major issue in most countries [1] To address this issue, the Japanese government introduced a long-term care insurance (LTCI) system in 2000. The LTCI system seeks provide long-term care services including home based services to support the growing number of community-dwelling elderly persons and their families, as in other countries [1]. Researching the effectiveness of home care services on community-dwelling elderly persons has become important in preventing deterioration of the level of disability, for the day-to-day lives of the elderly, and for the government in managing scarce health and social resources. Identifying the effect of home care services would contribute to standardization of and improvement in the quality of home care services
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