Japanese Long-term Care Insurance Research Articles

Trends in Life Expectancy With Care Needs Based on Long-term Care Insurance Data in Japan

BackgroundUsing a previously developed method for calculating expected years of life with care needs based on data from the Japanese long-term care insurance system, we examined recent trends in expected years of life with care needs by age group and prefecture.MethodsInformation on care needs was available from the long-term care insurance system of Japan. Expected years of life with care needs by age group and prefecture in 2005–2009 were calculated.ResultsExpected years of life with care needs at age 65 increased from 1.43 years in 2005 to 1.62 years in 2009 for men, and from 2.99 to 3.44 years for women. As a proportion of total life expectancy, these values show an increase from 7.9% to 8.6% in men and from 12.9% to 14.4% in women. Expected years with care needs did not increase in the age groups of 65 to 69 and 70 to 74 years but markedly increased in the age group of 85 years or older. Expected years with care needs increased in every prefecture during the period studied. The difference in 2005 between the 25th and 75th percentiles in prefectural distributions was 0.16 years for men and 0.35 years for women. The difference remained nearly constant between 2005 and 2009.ConclusionsExpected number of years of life with care needs increased among Japanese from 2005 to 2009, and there was a wide range in distribution among prefectures. Further studies on coverage of care needs under the long-term insurance program are necessary.

Assessment of vulnerable older adults’ physical function according to the Japanese Long-Term Care Insurance (LTCI) system and Fried's criteria for frailty syndrome

This study aimed to evaluate the physical frailty status of vulnerable older adults as classified in the Japanese LTCI system and to compare this with Fried's definition. A total of 444 older adults were classified based on the LTCI system as independent, vulnerable, or dependent, and 400 of these participants also fit Fried's criteria for not frail, pre-frail or frail. We evaluated their physical function with a 12 item physical function test. We derived a physical function score (PFS) from these 12 items and a principal component analysis was used to make comparisons. The receiver operating characteristic (ROC) curve analysis was performed to identify the sensitivity and specificity of the PFS cut-off points to distinguish the dependent category from the other categories. We found significant differences and a hierarchical order for the PFSs among the three groups of the LTCI system (the independent, 0.41±0.54; the vulnerable, −0.40±0.76; and the dependent, −1.49±0.73) and of Fried's definition (not frail, 0.50±0.51; pre frail, −0.11±0.63; and frail, −1.25±0.98). The optimal cut-off value (OCV) was −0.593. This study showed that the range of physical function of people considered frail category (pre-frail, vulnerable, and frail) is wide and overlapping. That is, the physical function of vulnerable older adults is worse than the pre-frail, but better than the frail. To better recognize older adults in need of greater support, the vulnerable should also receive assessment of their frailty status according to Fried's definition.

Exploring the Impact of the Japanese Long-Term Care Insurance Act on the Gendered Stratification of the Care Labour Market Through an Analysis of the Domiciliary Care Provided by Welfare Non-Profit Organisations

Japan's implementation of the Long Term Care Insurance Act in 2000 provides a good example with which to examine the restructuring process of care services for older people, as these have come to be commodified by the welfare state. By focusing on Welfare Non-Profit Organisations provision, this article explores the significance of gender in the restructuring process. It reveals that care services are stratified with institutional care placed at the top of hierarchy of care services costs, and domestic task services at the bottom. There is an unequal distribution of gender and organisational type for each type of care work.

Classification Tree Model Identifies Home-based Service Needs of Japanese Long-term Care Insurance Consumers

To clarify care receivers' needs and unmet needs for home help or home nursing services during daytime and/or nighttime hours, and to identify the characteristic of elders who are most likely to need home care services. We used a chi-squared automatic interaction detection technique to analyze data from 92 care management researchers, who interviewed 280 caregivers. Demographic information, assessments of the statuses and service needs of elders. We found that care receivers had more unmet needs at night than during the day. Daytime home help was needed by elders who (1) lived alone or (2) lived with just one person and whose primary caregiver was not their wife. Nighttime home help was needed by those who required assistance eating, and whose primary caregiver was male. Daytime home nursing was needed by elders who (1) received medical treatment instead of day care or (2) did not receive medical treatment, but had difficulty eating. Nighttime home nursing was needed by those who had unstable illnesses and whose medical treatments continued during the night. Our findings may help public health nurses assess community needs in order to effectively and efficiently manage health care resources.

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.

Horizontal Equity or Gatekeeping? Fiscal Effects on Eligibility Assessments for Long-term Care Insurance Programs in Japan

This paper considers the effects of municipal fiscal climates on eligibility assessments in the Japanese system of long-term care insurance (LTCI). We find that municipalities with more stringent fiscal climates tend to reject more applications for LTCI benefits, almost certainly in the hope of containing benefit expenditures. This would not be a serious problem if financial assistance from the upper levels of government counteracted the adverse effect. However, we also find that the effects of the assistance are almost negligible, despite layers of intergovernmental subsidies for municipal LTCI expenditures. In other words, horizontal equity in Japanese long-term care insurance is compromised for the sake of gatekeeping.

An Empirical Analysis of Patterns in the Japanese Long-Term Care Insurance System

The recently enacted Japanese long-term care (LTC) system was implemented to reduce the 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 use of LTC in Japan – particularly home care – is growing rapidly, as the elderly consumers find subsidized LTC care preferable to and more available than hospitalization. At the same time, regional disparities in terms of entitlement and care use persist and are likely to grow.

Legal Establishment of the Care Manager System in the Korean Long-Term Care Insurance Law - Reflections from the Care Manager System in the Japanese Long-Term Care Insurance

Legal Establishment of the Care Manager System in the Korean Long-Term Care Insurance Law - Reflections from the Care Manager System in the Japanese Long-Term Care Insurance

Collective synchronization as a method of learning and generalization from sparse data

We propose a method for extracting general features from multivariate data using a network of phase oscillators subject to an analogue of the Kuramoto model for collective synchronization. In this method, the natural frequencies of the oscillators are extended to vector quantities to which multivariate data are assigned. The common frequency vectors of the groups of partially synchronized oscillators are interpreted to be the template vectors representing the general features of the data set. We show that the proposed method becomes equivalent to the self-organizing map algorithm devised by Kohonen when the governing equations are linearized about their solutions of partial synchronization. As a case study to test the utility of our method, we applied it to care-needs-certification data in the Japanese public long-term care insurance program, and found major general patterns in the health status of the elderly needing nursing care.

Difficulties experienced by care managers who are care workers managing elder abuse cases in the Japanese long-term care insurance system

The purpose of the present study is to describe the difficulties perceived by care managers in Japan when managing care in cases of abuse of elderly people in the home. Participants (n = 21) were female care managers who had handled an abuse case while working for an in-home care management service provider. Participants had a mean of 4.3 +/- 0.7 years of experience as a care manager. Interview data were collected from 2004 to 2005 and analysed according to the grounded theory approach. Seven categories and one core category of difficulties were extracted from the data. The core category was 'tacit control of care management by the abusive caregiver'. The other categories were as follows: the terrible situation of the people abused cannot be ignored; the long-term care insurance service is the only support for abused people; the abusive caregiver has the authority to cancel the contract; concerns that intervention might increase abuse; prioritising how to deal with the abuser rather than the abused is unavoidable; the abusive caregiver deciding the needs of the individual requiring care; and creating a care plan that is acceptable to the caregiver. Therefore, the present results suggest the necessity of not only treating the role of care managers as an important position within the care system that deals with elder abuse, but also highlight the need to establish a system that supports care managers in order to promote appropriate care management.

Effects of a 3-month Fall Risk Reduction Exercise Program for Determined Care Level of Assistance Required Under the Japanese Long-Term Care Insurance System

Effects of a 3-month Fall Risk Reduction Exercise Program for Determined Care Level of Assistance Required Under the Japanese Long-Term Care Insurance System

Nursing Home and At-home Ethics for the Elderly : everyday and institutional issues and their prospects under the Japanese long-term nursing care insurance system

Nursing Home and At-home Ethics for the Elderly : everyday and institutional issues and their prospects under the Japanese long-term nursing care insurance system

The effect of a subsidy policy on the utilization of community care services under a public long-term care insurance program in rural Japan

This cross-sectional study investigated the effect of an interim subsidy policy for low-income beneficiaries to buy home help services under Japanese long-term care insurance (LTCI) for the service utilization of home help and other community care services. Claims records during the period from October to December 2001 were reviewed to compare the monthly amounts for each service and out-of-pocket copayment for subsidized ( n = 137) and non-subsidized ( n = 124) beneficiaries. A multivariable linear regression analysis was conducted to control for age, gender, household size, length of care, and care eligibility level. Compared with the non-subsidized beneficiaries, the subsidized beneficiaries used 1.53 times as much home help service ( p < 0.001), and spent 0.70 times as much on out-of-pocket copayments ( p < 0.001), while they used fewer adult daycare services (0.71 times as much as the non-subsidized did, p = 0.063). The results strongly indicated that the interim subsidy for low-income beneficiaries alleviated the economic burden, but also resulted in service overuse and the substitution of home help services for other community care services. The policy implications of these findings were discussed.

Lessons from the 5-Year Experience of Japanese Long-term Care Insurance

Lessons from the 5-Year Experience of Japanese Long-term Care Insurance

Differences in Facilities' Acceptance of Patients Under Long-Term Care Insurance in Japan

Objectives. In April 2000, Japan launched a public, long-term care insurance (LTCI) plan for elderly people who need support. This study describes how medical support for the elderly is delivered at LTCI care facilities in Japan now and gaps between system goals and current activity. Recommendations are made for enhancing the implementation of LTCI. Methods. We mailed questionnaires to all health service facilities for the elderly (HSF) and special nursing homes for the elderly (SNH) located in the Kyushu area of Japan, asking whether they would accept patients with nine specific conditions. Results. We found that HSFs, which are required to employ a full-time doctor and are reimbursed at a higher rate, accept significantly fewer patients with four conditions that need medical support than are accepted by SNHs, which are not required to employ a full-time doctor. Discussion. In this study, we find discrepancies between system goals and current activities at LTCI care facilities. For the Japanese LTCI system to work well in the limitation of medical resources, we must understand how it really works and to reform the system continuously.

Overview of the Japanese long-term care insurance system current and future

Overview of the Japanese long-term care insurance system current and future

Independence, Security, and the Intergenerational Social Contract: Home-Helper Services and Elder Care in Rural Japan

For several years, demographic trends and changing ideas about responsibilities for elder care in Japan have contributed to the desire, or need, for families to seek out new care approaches. This article focuses on one alternative to traditional approaches to caring for elder family members--the home-helper program that is available through the Japanese long-term care insurance program. Using ethnographic data collected in northern Japan, it will be argued that the home-helper program forms a compensatory elder care system that is intended to augment family-provided care and social support, rather than to promote independent living. This compensatory approach to elder care is based upon an intergenerational social contract in which it is assumed that some degree of dependence on family members is both an expected and preferred outcome of growing old.

Are the care levels of people with dementia correctly assessed for eligibility of the Japanese long-term care insurance?

A new long-term care insurance system was launched in Japan in April 2000. We performed the first national survey on special units of psychiatric hospitals for dementia patients to examine whether their disabilities were well reflected in the eligibility assessment. Of all 248 dementia special units of psychiatric hospitals in Japan, 180 units (72.6%) participated in the survey. Five patients were randomly selected in each unit, and we used data of 802 (89.1%) of 900 patients whose care levels were obtained by the primary computer assessment. These patients were assessed using the Mini-Mental State Examination (MMSE), dementia rating scale by Gottfries et al. (1982) (GBS), and Activities of Daily Living (ADL). The mean score (SD) of the MMSE was 9.3 (6.9). Multiple regression analysis revealed that the scores of motor function in GBS, ADL, MMSE, and the degree of bedridden explained 73% of the variation of care level. The higher care levels were inversely related to lower MMSE scores. In the group of people who were not bedridden, the MMSE score sharply decreased even though their physical functions were maintained. There were no significant differences in the MMSE scores among the care level 1 and 5 groups except between care level 1 and 3 after controlling for the motor function scores in GBS. Our results suggest that care level and cognitive impairment are generally correlated in the primary assessment, but some adjustment measure for cognitive impairment is needed in mildly or moderately physically disabled patients.

Creation of the long-term care insurance and its significance for the restructuring of the Japanese welfare state

The Japanese Diet passed the Long-term Care Insurance Bill in December 1997. The Long-term Care Insurance Law which creates universal long-term care insurance scheme shall come into force on the 1st of April, 2000.This paper aims to elucidate basic issues that should be examined and to present an analytical framework for sociological analysis of the significance of the creation of the long-term care insurance for the restructuring of the Japanese welfare state.Firstly, policy factors which led to the creation of the long-term care insurance are analyzed in terms of the continuities and changes in the long-term care policies of the Japanese government in the 1980s and the 1990s.Secondly, seven basic characteristics of the institutional design of the newly-created long-term care insurance are examined : universality of benefits, orientation to the national minimum of care service, adequacy of benefit level, financial arrangements, user charge, coordination of medical, health and welfare services, and the roles and functions of profit and non-profit organizations.Finally, social and policy significance of the creation of the long-term care insurance is examined using the theoretical frameworks of (1) the welfare state regime theory developed by G. Esping-Andersen, (2) gender approach to the welfare state typology, and (3) typology of welfare pluralism. Preliminary conclusions of this analysis are (1) that the newly-created scheme will function to maintain and reinforce the conservative nature of the Japanese social security regime, (2) that it will have more or less defamilializing effects in terms of the expansion of formal care services, and (3) that the contrasting nature of the Japanese long-term care insurance scheme and the British community care reform can be clarified by introducing the dual typology of the market-oriented and participation-oriented welfare pluralism, and the service-purchasing type and user-subsidizing type of welfare pluralism.