Long-term Care Insurance In Japan Research Articles

Perceived chewing ability and need for long‐term care in the elderly: a 5‐year follow‐up study

Increasing need for long-term care in older adults is expected with the ageing of Japan's population. The aim of the present study was to show the relationship between perceived chewing ability and long-term care needs for over 5 years in elderly persons. The chewing ability of 812 elderly persons living independently was evaluated at baseline using self-assessed masticatory ability, and it was classified into one of three categories: ability to chew all foods (good masticatory ability), ability to chew only slightly hard food (fair masticatory ability), and ability to only chew soft or pureed food (poor masticatory ability). Participants' care needs were then followed through Japan's long-term care insurance system for over 5 years. The log-rank test and Cox proportional hazard model were used to examine statistical differences in the frequency of care-needs certification between participants with good and fair or poor masticatory ability. Among participants aged 65-79 years, the frequency of care-needs certification was significantly higher in those with fair or poor masticatory ability than in those with good masticatory ability, and the relative hazard ratio was significantly higher in those with fair or poor masticatory ability than in those with good masticatory ability, after adjusting for age, gender, current employment status, educational background, social interaction, chronic medical conditions and dentition status. These relationships were not found among those aged 80-93 years. Impairment in perceived chewing ability may be associated with higher incidence of certification in Japan's long-term care insurance system among elderly persons aged 65-79.

P1-356 Relationship between proportion of budget expenditure for health services for disability prevention and that for long-term care insurance in Japan

IntroductionThe government of Japan encourages municipalities to promote Health Services for Disability Prevention (HSDP) to contain the increasing trend of Long-term Care Insurance (LTCI) expenditure for the care of aged...

Association between components of family caregivers’ sense of burden and types of paid care services provided in Japan

Objectives: The aim was to identify significant relationships between the 21 components of caregivers’ sense of burden in the Zarit Burden Interview and specific paid care services provided in Japan's long-term care insurance system. Method: We defined a service utilization level (SUL) that represents the amount of care services that caregivers were consuming. We calculated the ratios of people, among those with the same SUL value, whose sense of burden was weaker than a specific level. Finally, we conducted regression analysis and checked how this ratio varied compared to the change in SUL values. Results: For 12 among 22 components, the use of paid care services in general were significantly and linearly related with a smaller number of people having the strongest sense of burden. Several pairs of burden components and care service types were identified indicating that the type of care services effectively alleviated that burden component. Conclusions: (1) Paid care services do relieve caregivers’ sense of burden. (2) Measures to increase the ratio of people with the weakest sense of burden by encouraging the use of care services do not necessarily match those that decrease the ratio of people feeling the heaviest burden. (3) Policies that encourage caregivers to use more care services can be more effective if policy makers know which type of care service is related with a burden component.

Impact of home and community-based services on hospitalisation and institutionalisation among individuals eligible for long-term care insurance in Japan

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.

On the consumption insurance effects of long-term care insurance in Japan: Evidence from micro-level household data

Using micro-level household data in the 2001 Comprehensive Survey of the Living Conditions of the People on Health and Welfare compiled by the Japanese Ministry of Health, Labor and Welfare, this paper examines how having a household member in need of long-term nursing care can result in welfare losses measured in terms of consumption. In so doing, this study evaluates the role of the public long-term care insurance scheme implemented in Japan in April 2000. The results indicate that when households include a disabled family member, household consumption net of long-term care costs do not decrease as much as before the introduction of long-term care insurance. Further, when compared with the surveys conducted in 1998, the adverse effects on consumption net of long-term care costs have become much weaker. These findings suggest that the introduction of social insurance in 2000 helped Japanese households to reduce the welfare losses associated with a disabled family member.

認知症の人の看取りにおける医療と介護の連携に関する研究―医療法人と社会福祉法人運営のグループホームへのアンケート調査より―

The number of group homes for elderly people with dementia has been increasing since the introduction of public long-term care insurance in Japan. The aim of this report is to clarify the differences in the end-of-life policy and practices among group homes managed by medical corporations and those run by social welfare corporations. A questionnaire for end-of-life care policy and practices was mailed to 1,535 group homes managed by medical corporations and 2,022 group homes managed by social welfare corporations. The questions related to the general characteristics of group homes, availability of admission to hospital, whether a doctor visits regularly or not, involvement in end-of-life care, experiences of previous end-of-life care, and provisions for anticipated end-of life care. The response rates were 55.2% for medical corporations and 59.6% for public welfare corporations. Most group homes have one care unit. More than 50% of medical corporation-managed and more than 30% of social welfare corporation-managed group homes were involved with end-of-life care. Previous experiences with end-of-life care experienced in both types of group homes were reported to be 38.0% and 30.1%, respectively. The results of end-of-life care were evaluated positively in both types of group home. Group homes managed by medical corporations which also managed hospitals and group homes managed by social welfare corporations with regular visits of doctors showed a high percentage of cooperation with and previous experience of end-of-life care. Cooperation between medical and care staffs in end-of-life care of the elderly with dementia in group homes is important. This report demonstrated that education about end-of-life care to the staffs of group home is necessary.

Predictors of continuity in home care for the elderly under public long-term care insurance in Japan

With the rapid increase in the elderly population, the number of people requiring care is also increasing and the capacity of the family to provide care is decreasing. Because institutionalization costs are high, more research is needed to investigate predictors of preventing institutionalization. The aim of this study was to examine the impact of social engagement and other predictive factors, including disability, household composition, and formal services, on continuity in home care of the elderly. The study was retrospective longitudinal in design. Data were collected from elderly people living in the community who were certified as eligible for care level 2-5 under Japanese long-term care insurance. Continuity in home care was defined as a participant living at home 1 year after the beginning of the study. Of 244 participants, 200 continued to receive home care (82%). Based on a logistic regression analysis predicting continuity in home care, after controlling for gender, age, initial care level, household composition, and daycare service use, having friends was significantly associated with continuity in home care (odds ratio [OR] 2.42; 95% confidence interval [CI] 1.04-5.65). Participants who lived alone or with a spouse were less likely to continue to receive home care compared with those who lived with others (OR 0.27; 95% CI 0.08-0.87 and OR 0.18; 95% CI 0.06-0.53, respectively). Having friends was a significant predictor of continuity in home care. The promotion of social engagement may be important in preventing institutionalization.

Japan's long-term care insurance

When the NHS was established, ‘health care’ was made available to all and free at the point of delivery, but ‘social care’ remained with the local authorities and continued to be provided after a means-test (i.e. only for the poor). With the aging of society, the dividing line between health and social care has become blurred. Older people need a complex combination of both services.

P3-437: Public care services for dementia patients and the care level by the long-term care insurance in Japan: Silver Rehabilitation Foundation Project

P3-437: Public care services for dementia patients and the care level by the long-term care insurance in Japan: Silver Rehabilitation Foundation Project

Coping strategies, care manager support and mental health outcome among Japanese family caregivers

Coping and social support are regarded as major modifiers of the caregiving stress and negative mental health effects experienced by caregivers. Under Japan's Long-term Care Insurance (LTCI) system, care managers have played a major role in providing psychosocial support for family caregivers while coordinating formal and informal care resources for elderly people. However, since the launch of the LTCI system in 2000, no evaluation has examined the role care managers play in buffering the negative effects of the caregiver burden among family caregivers in Japan. This study examined the direct and buffering effects of stress-coping strategies and care manager support on caregiver burden and depression among Japanese family caregivers (n = 371) caring for community-dwelling persons aged 65 or over who were having difficulties with the activities of daily living. A self-administrated questionnaire survey was conducted between February and March 2005 in a rural suburb in south-western Japan. Hierarchical regression analyses revealed the following. (i) Coping strategies and 'social talk' by care managers had direct effects on caregiver burden and depression. (ii) 'Avoidant' coping and 'social talk' by care managers had buffering effects on the care needs-depression relationship. (iii) 'Information giving' by care managers had no significant direct effect, but it had a negative effect on the care needs-depression relationship. Overall, results concerning 'approaching' coping were in line with those of previous studies, while findings concerning 'avoidant' coping were not consistent with findings in Western countries. The type of care manager support appeared to have a variable influence on caregiver burden and depression.

Developments in Long-Term Care Insurance in Japan

The recently-enacted Japanese long-term care (LTC) system was implemented to reduce so-called social hospitalization or warehousing of the elderly in expensive medical facilities. This paper seeks to evaluate recent patterns in Japanese LTC use and examine the factors associated with LTC utilization patterns. We show that the demand for LTC in Japan - particularly home care - is growing rapidly, as elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in care persist and are likely to grow.

Health-related quality of life and beneficiaries of long-term care insurance in Japan

Objectives A long-term care insurance (LTCI) system was introduced in 2000 in Japan. The clarification of information on the users and the ways in which services under this system have been utilized is essential for improving the system operation. This study was conducted for the purpose of clarifying what level of health-related quality of life (HRQOL) was achieved by individuals using the services under the LTCI system. Methods The subjects were inhabitants of two cities in the Kyushu district of Japan who were receiving daily home care services under the LTCI system. To analyze the relationships of the beneficiaries’ HRQOL with their characteristics, the dependent variable was the EuroQol-5D (EQ-5D) scores adopted as an index of HRQOL, and the independent variables comprised the demographic features (gender, age, and living condition) of users receiving long-term care service as well as their opinions about fees for services, satisfaction with the services provided, and the degree of support/care required. Results The EQ-5D score was higher for females than for males and higher for the subjects living alone than for those displaying any other family composition. EQ-5D score decreased with an increase in the degree of support/care required. Multivariate analysis revealed that the degree of support/care required, gender and living condition were found to serve as variables that significantly contribute to utility. Conclusions Our analysis of the relationships between the characteristics of the LTCI beneficiaries and their HRQOL has yielded basic data that will be useful for improving the recently introduced LTCI system.

Rationale, Design and Sustainability of Long-Term Care Insurance in Japan – In Retrospect

When Japan introduced a new public long-term care insurance in 2000, the eligibility criteria and benefits were designed so that those who had been receiving services would be able to continue to do so. Five years later, benefits were reduced by a partial levying of hotel costs in institutional care, and restricting the provision of instrumental activities of daily living support services in community care for those requiring only light care. Whether these revisions are effective in containing costs and whether a decision should be made to cover all ages and all disabilities are the issues for the future.

Clinical Status and Dependency of the Elderly Requiring Long-Term Care in Japan

More than 4 million of the elderly receive long-term care services using the public long-term care insurance in Japan. In order to use the insurance system, the insured person needs to be classified in one of the six care levels according to his/her clinical status. Though each level is defined in terms of the total amount of estimated care time needed per day, the clinical status of each level is not precisely defined. This study aimed to compare the clinical status of the six levels in order to suggest indicators of deterioration for each care level. We analyzed the clinical status for 7,222 cases who applied for care-need certification in a rural area of Japan. Sixty-seven items were used to determine physical function, activities of daily living, and cognitive and sensory status. Even in the mildest care level (Support Required), more than 50% of the individuals were dependent with regard to standing and sitting, while weakness of the lower extremities and dependency in walking were identified in Care Level 1, dependency in dressing and toilet habits in Care Level 2, dependency in grooming and transferring in Care Level 3, dependency in communication and feeding in Care Level 4, and dependency in swallowing, orientation and limitations of joint movement in Care Level 5. Care providers should be tracking these changes to estimate and prevent the decline of care level because more than 20% of the individuals assessed in 2004 belonged to the worse care level one year later.

Long-term Care Insurance in Japan: Implications for U.S. Long-term Care Policy

The purpose of this article is to review the long-term care insurance program in Japan and the present system of payment of long-term care services in the United States. The long-term care insurance system in Japan was implemented in 2001 for the purpose of promoting independence in older adults with functional disability. It reimburses for both home and institutional care. Several concerns expressed about the Japanese system include increasing applications for nursing home placement, lower use of home care services than anticipated, limited coverage for disabilities for those under 65, regional variations in service, educational preparation for case managers, and access to care for older adults. Revisions to the Japanese system and implications for U.S. long-term care policy are discussed.

Reconsidering the Caregiving Stress Appraisal scale: Validation and examination of its association with items used for assessing long-term care insurance in Japan

The Caregiving Stress Appraisal (CSA) scale is a simple scale for measuring family caregiver stress. However, information on its validity and association with new social welfare systems in Japan is inadequate. The purpose of the present study is to examine the criterion validity of the CSA and to explore its association with the variables used for assessing long-term care insurance in Japan. In the present study, 219 family caregivers completed a self-administered questionnaire. Of these, 50 and 202 caregivers were used for the analysis of the criterion validity and construct validity, respectively. The CSA, the Japanese version of the Zarit Burden Interview (J-ZBI), the Center for Epidemiological Studies-Depression (CES-D), and the items used for assessing long-term care insurance in Japan were used for the analyses. The results revealed that the CSA had significant correlations with the J-ZBI and the CES-D. Despite the small sample size, the CSA had significant correlations with the items used for assessing long-term care insurance in Japan. These results suggest sufficient criterion and construct validity of the CSA for the future study.

Changes in Stroke Rehabilitation Outcomes After the Implementation of Japan’s Long-Term Care Insurance System:

To explore the changes in stroke rehabilitation outcomes after the introduction of Japan's long-term care insurance (LTCI) system. Stroke patients discharged during a 3-yr period before and after the implementation of LTCI were compared (before-LTCI vs. after-LTCI). Outcome measures included onset to admission interval, length of stay, and correlation between discharge site and functional level at discharge. A total of 201 patients in the before-LTCI group and 252 patients in the after-LTCI group were eligible for the study. Shorter mean length of stay (P < 0.01) and higher rates of discharge to a rehabilitation facility (P < 0.01) were found in the after-LTCI group. Logistic regression analysis revealed that the patients with higher activities of daily living scores or ambulatory status at discharge were more likely to be discharged to home after inpatient rehabilitation in both groups (P < 0.01). The rate of discharge to home was similar in both groups. Within this rehabilitation hospital's experience, the mean length of stay was reduced after the implementation of the LTCI. Although it was one of the primary goals of the LTCI, the rate of discharge to home did not significantly increase. Further evaluation and modification of the LTCI and more efforts to improve a patient's activities of daily living and ambulatory status at discharge will be necessary to promote in-home care in Japan.

HOMICIDES OF DISABLED OLDER PERSONS BY THEIR CAREGIVERS IN JAPAN

HOMICIDES OF DISABLED OLDER PERSONS BY THEIR CAREGIVERS IN JAPAN

Care‐Needs Certification in the Long‐Term Care Insurance System of Japan

The introduction of Japan's long-term care insurance (LTCI) system in April 2000 has made long-term care an explicit and universal entitlement for every Japanese person aged 65 and older based strictly on physical and mental status. At the start of the program, more than two million seniors were expected to apply for services to approximately 3,000 municipal governments, which are the LTCI insurers. The LTCI implementation required a nationally standardized needs-certification system to determine service eligibility objectively, fairly, and efficiently. The current computer-aided initial needs-assessment instrument was developed based on data collected in a large-scale time study of professional caregivers in long-term care institutions. The instrument was subsequently tested and validated by assessing data of 175,129 seniors involved in the national model programs before the start of LTCI. The computer-aided initial assessment (an 85-item questionnaire) is used to assign each applicant to one of seven need levels. The Care Needs Certification Board, a committee of medical and other professionals, reviews the results. Three years after implementation, the LTCI system and its needs-assessment/certification system have been well accepted in Japan. Despite the overall successes, there remain challenges, including area variations, growing demands for services, and the difficulty of keeping the needs certification free of politics. The LTCI computer network that links municipalities and the central government is instrumental in continuously improving the needs-certification system. Future challenges include promoting evidence-based system improvements and building incentives into the system for various constituencies to promote seniors' functional independence.

Role of Physical Therapists to Prevent Usage of the Long-Term Care Insurance in Japan

Role of Physical Therapists to Prevent Usage of the Long-Term Care Insurance in Japan