Long-term Care Facilities In Japan Research Articles

Factor structure of “personhood” for elderly healthcare services: a questionnaire survey of long-term care facilities in Japan

Objective: The purpose of this study was to develop the Personhood Questionnaire (PQ) to determine the factor structure of “personhood” for elderly healthcare services and identify personhood components other than PQ items. Method: We enrolled 314 healthcare professionals at long-term care facilities in Japan. Participants completed a questionnaire consisting of 17 PQ items. The PQ was designed to assess the degree of need in elderly healthcare services on a 5-point Likert scale (Question 1), and identify personhood components other than PQ items (Question 2). We performed factor analysis for answers to Question 1, and text mining and cluster analysis for answers to Question 2. Results: Factor analysis revealed a four-factor structure. Cronbach’s α was 0.87 for the 17 original items and 0.86 for the 15 items after removing two items. Text mining identified 27 personhood components, which were classified into three clusters. The second cluster consisted of non-PQ items. Conclusions: Factor 1 was “forming daily life,” factor 2 was “forming career and context,” factor 3 was “affecting psychological behavior,” and factor 4 was “forming basic attributes.” Components of the second cluster require further examination before incorporation into the concept of personhood.Implications for RehabilitationImproving the quality of individualized care, in which “personhood” and dignity of elderly people are respected, is an urgent goal.The Model of Human Occupation (MOHO), a conceptual practice model for occupational therapy, should be used jointly with the International Classification of Functioning, Disability and Health (ICF) to establish the concept of personhood.The construction of personhood in elderly health care services consists of a four-factor structure, including “forming daily life,” “forming career and context,” “affecting psychological behavior,” and “forming basic attributes.”This study suggests that provision of high-quality individualized care can be achieved by promoting services that focus on “forming daily life,” which has the highest factor contribution.

A national survey of the use of physical restraint in long‐term care hospitals in Japan

To investigate the prevalence of physical restraints in the long-term care hospitals in Japan and to examine the factors of physical restraint use, including the specific skills/techniques that the staff use to minimise the restraints. Background. Despite the national efforts to nullify physical restraint, it is still prevalent in long-term care facilities in and out of Japan. More detailed information regarding what affects physical restraint is needed. Cross-sectional mail survey. A questionnaire was sent to a nursing ward manager of the random sample of long-term care facilities in Japan. The average rate of physical restraint was 25·5%. Altogether, 81·0% of the restrained clients were under restraint for more than one month. The most prevalent method of restraint was bilateral bedrails, followed by the use of coveralls and gloves. Factors of restraint were different depending on the type of restraint, suggesting specific approaches are needed for specific type of restraint. Physical restraint is still prevalent in Japanese long-term care hospitals, and nurses need to develop effective intervention approach to redesigning practice related to physical restraints. Specialised intervention approach seems needed depending on the types of restraint. Specific approach should be developed to minimise the physical restraint in long-term care hospitals in Japan.

Editorial: New drugs for Alzheimer's disease in Japan

Editorial: New drugs for Alzheimer's disease in Japan

Dietitian's Involvement in Managing Food Types of Dysphagia Diets and Its Effect at Long-Term Care Facilities in Japan

Dietitian's Involvement in Managing Food Types of Dysphagia Diets and Its Effect at Long-Term Care Facilities in Japan

Management of behavioral and psychological symptoms of dementia in long‐term care facilities in Japan

An increasing number of old people, and their medical requirements, cannot be managed by their families in their homes, which has been the traditional and prevalent practice in Japan. The number of people with dementia is increasing and behavioral and psychological symptoms of dementia (BPSD) make care difficult. In the present study, we investigated management techniques for BPSD in long-term care facilities in Japan by using the data mining method, which looks at the reported behaviors of care providers. First, interviews were conducted with 15 care providers to develop items for a questionnaire. These data were analyzed qualitatively and synthesized with criteria from the professional literature. The resulting self-report questionnaire on techniques used to manage different symptoms of dementia was completed by 275 care providers. We applied the association rule as a data mining method examining 15 management techniques related to 13 BPSD. Analysis identified four types of management techniques: (i) emotional and behavior-concordance techniques; (ii) acceptance and supportive techniques; (iii) restraining techniques; and (iv) avoidance techniques. Different management techniques, and combinations of techniques, were found to vary in use and effectiveness with different BPSD. Good management techniques for many BPSD have been developed and are being implemented by care providers. The present study has the potential to inform researchers and care providers in Japan about the types of management techniques in current use, as well as areas of potential need for staff training.

Administrators’ perspectives on end-of-life care for cancer patients in Japanese long-term care facilities

The purpose of this study was to clarify administrators' perspectives on availability of recommended strategies for end-of-life (EOL) care for cancer patients at long-term care (LTC) facilities in Japan. A cross-sectional survey was conducted with administrators at Japanese LTC facilities. Participants were surveyed about their facilities, reasons for hospitalization of cancer patients, and their perspectives on availability of and strategies for EOL care. The 97 responses were divided into medical facility (n = 24) and non-medical facility (n = 73) groups according to physician availability. The most frequent reasons for hospitalization were a sudden change in patient's condition (49.4%), lack of around-the-clock care (43.0%), and inability to palliate symptoms (41.0%). About 50% of administrators believed their facilities could provide EOL care if supported by palliative care experts. There was no significant difference between facility types (P = 0.635). Most administrators (81.2%) regarded unstable cancer patients as difficult to care for. However, many (68.4%) regarded opioids given orally as easy to administer, but regarded continuous subcutaneous infusion/central venous nutrition as difficult. Almost all administrators believed the most useful strategy was transferring patients to hospitals at the request of patients or family members (96.9%), followed by consultation with palliative care experts (88.5%). Although LTC facilities in Japan currently do not provide adequate EOL care for cancer patients, improvement might be possible with support by palliative care teams. Appropriate models are necessary for achieving a good death for cancer patients. Interventions based on these models are necessary for EOL care for cancer patients in LTC facilities.

Caregivers' decisions on placement of family members in long-term care facilities in japan: Analysis of caregiver interviews

Factors influencing caregivers' decisions to place their older family members in nursing homes were explored. Data were based on interviews with primary caregivers, and patient records of a Geriatric Intermediate Care Facility during the eight-year data collection period. Findings show that over half of the primary caregivers (55%) decided to place their older family member in a nursing home due to their incapability of providing care rather than the older adult's declining physical or cognitive functioning. Although it is reported that the Japanese, whose culture is embedded in filial piety, stigmatize the notion of placing their older adults in nursing homes, results of this study suggest their attitudes may be changing. Practice implications for healthcare professionals based on findings are provided.

Unlocking housing equity in Japan

Much prior literature on asset patterns among the elderly has mostly overlooked housing wealth as a determinant of retiree wealth, particularly in the Japanese context. Yet releasing equity in housing may be a natural mechanism to boost consumption, reduce public pension liability, and mitigate the demand for long-term care facilities in Japan. Our study evaluates what might be needed to implement reverse mortgages (RMs) in this country. Policies could include exempting RMs from capital gains tax and transactions tax, along with mechanisms to make annuity income flows nontaxable, along with interest rate accruals for RMs. In addition, housing market reforms to enhance information flows would be needed, particularly regarding new and existing housing trades, which could permit the securitization of housing loans and lines of credit. Other improvements in capital markets could also help, including the establishment of reinsurance mechanisms to help lenders offer these reverse mortgages while having some protection against crossover risk. In the Japanese case, demand for RMs will be dampened by declining residential housing values as well as low interest rates and long life expectancies. Nevertheless, we conclude that RMs can be a good way to finance elderly consumption in Japan, particularly against the backdrop of governmental financial stringencies. J. Japanese Int. Economies 18 (4) (2004) 466–505.