Long-term Care Insurance Beneficiaries Research Articles

Characteristics of first-time users of the nursing small-scale multifunctional home care service: a pooled cross-sectional study using Japanese long-term care insurance claims data from 2012 to 2019

ObjectivesIn April 2012, the Japanese government launched a new nursing service called the nursing small-scale multifunctional home care (NSMHC) to meet the nursing care demands of individuals with moderate-to-severe activities...

Choice of formal and informal care among community-dwelling older people with or without dementia under a long-term care insurance pilot program in China.

This study examines the use of publicly funded formal and informal care among community-dwelling long-term care insurance (LTCI) beneficiaries in China and how dementia differentiates the choice of care. Using administrative data from a LTCI pilot scheme in Guangzhou (n = 2043), we conducted a multinomial logistic regression to examine the association between dementia and the choice of family members (informal unpaid care), domestic helpers (informal paid care) and care workers (formal care), controlling for demographics, living environment and intensity of paid care hours. Most LTCI beneficiaries chose a family member (65%), followed by a domestic helper (21%) and a care worker (14%). After controlling for covariates, LTCI beneficiaries with dementia were more likely than their counterparts without dementia to choose care provided by a care worker (RRR: 1.73) or a living-in helper (RRR: 1.43) than a family member. A preference for informal care was observed among LTCI beneficiaries in China. Those with dementia were more likely than those without dementia to use care provided by non-family caregivers. The pilot scheme findings provide further insight into care recipients' preferences for service utilisation and how dementia impacts these preferences, which should be considered in future policy and service provision.

THE BENEFITS OF LONG-TERM CARE INSURANCE FOR FAMILY CAREGIVERS: EVIDENCE FROM CHINA

Abstract This paper aims to evaluate the impacts of the long-term care insurance (LTCI) program on family caregivers of older adults with functional limitations in mainland China. The study used data collected from 1,658 LTCI beneficiaries or those in the LTCI application process in 16 pilot Chinese cities in 2021. Descriptive statistics, chi-square tests, and multiple regression analyses were used to analyze the data. The results indicate that LTCI beneficiaries are more likely to receive institutional care than non-beneficiaries (27.8% vs. 16.8%), reducing the responsibilities and potential burden of family caregivers. LTCI beneficiaries are also more likely to receive social care services than non-beneficiaries (35.9% vs. 26.7%). Family caregivers of LTCI beneficiaries spend less time per day on care than non-beneficiaries (15.45 vs.16.59 hours), and they are less likely to delay their work due to caregiving (41.4% vs. 60.7%). Additionally, LTCI has a positive impact on various aspects for family caregivers, with over 40% reducing their caregiving time, 55.0% reducing care service costs, 68.5% feeling that LTCI has reduced their physical burden, and 77.9% indicating that their psychological burden has been lessened. The study concludes that the establishment of long-term care insurance nationwide should be promoted as the pilot sites have seen significant positive effects on family caregivers. LTCI should also consider more direct support to family caregivers.

Pet ownership-related differences in medical and long-term care costs among community-dwelling older Japanese.

This study examined the differences in medical and long-term care costs over 18 months between pet owners and non-owners among community-dwelling older Japanese. Pet ownership data were collected from 460 community-dwelling adults age 65 years and older. These data were matched with data from the National Health Insurance, health insurance for older people, and Long-Term Care Insurance beneficiaries for 17 months back from the survey on pet ownership. Pet-ownership group-specific trajectories in monthly medical and long-term care costs were modeled by a generalized estimating equation. Among pet owners (n = 96, 20.9%) and non-pet owners (n = 364, 79.1%) there were no significant differences in baseline demographic or health characteristics including chronic disease and self-reported long-term care level. At baseline, pet owners had estimated monthly medical costs of ¥48,054 (SE = 0.11; $418), compared to ¥42,260 (SE = 0.06; $367) for non-pet owners. The monthly medical costs did not differ significantly between the two groups during the 18-month follow-up period. At baseline, estimated monthly long-term care costs of pet owners and non-pet owners were ¥676 (SE = 0.75; $6) and ¥1,420 (SE = 0.52; $12), respectively. During the follow-up period, the non-pet owner to owner ratio of monthly long-term care costs was 1.2 at minimum and 2.3 at maximum. This study showed that monthly long-term care costs for pet owners were approximately half those of non-pet owners. Pet owners might use long-term care services less frequently, or use lighter care services.

Impact of long-term care insurance on medical costs and utilization by patients with Parkinson's disease

BackgroundIn patients with Parkinson's disease (PD), long-term care insurance (LTCI), which can provide physical activity, might affect medical costs and utilization. We investigated the impact of LTCI on medical costs and utilization among patients with PD aged ≥60 years. MethodsData were derived from the 12-year Korean National Health Insurance Service‒Senior cohort. Among patients with newly developed PD, the intervention group receiving LTCI was matched with the control group using propensity score risk-set matching. As medical costs and utilization may increase markedly immediately before LTCI allocation, the baseline period was set from 5 years to 1 year prior to receiving LTCI. Medical costs and utilization were recorded in six 1-year intervals thereafter. We compared medical costs and utilization between groups using a comparative interrupted time-series analysis. Results5011 LTCI beneficiaries and 5011 propensity score- and risk-set-matched controls were included. The overall mean (standard deviation) age was 77.73 (5.7) years, and 66.2% were women, in both groups. LTCI benefit was associated with reduced overall direct medical costs for 5 years (post-intervention year 5: -270$, p = 0.033), and overall hospital length-of-stay (LOS) for 2 years post-LTCI (post-intervention year 2: -2.43 days, p = 0.002), although medical costs and LOS increased immediately pre-LTCI implementation. The long-term care hospital LOS of LTCI beneficiaries increased relatively by 3-years post-LTCI implementation, particularly in those with a high Charlson Comorbidity Index score (post-intervention year 3: +2.65 days, p = 0.04). ConclusionsLTCI benefit stably decreased medical costs for patients with PD for 5 years, despite the steep increase immediately pre-LTCI benefit, but was limited in reducing medical utilization, particularly as reflected by LOS in long-term care hospitals and patients with comorbidities. LTCI could be a useful health policy to reduce PD disease burden. However, further development is required to provide services that can reduce LOS to PD patients with comorbidities.

Validation of using disqualification from long-term care insurance registry as a proxy of death

Objectives The national database for long-term care insurance (LTCI) of Japan (Kaigo DB) enables researchers to access comprehensive data from its LTCI registry, eligibility assessment records, claims for service usage, and information about service providers. However, studies regarding the death or mortality of beneficiaries cannot be conducted because Kaigo DB does not contain death records, and researchers are not allowed to link Kaigo DB to other databases, such as national death records. Therefore, we aimed to assess the validity of using an insurer's disqualification from an LTCI beneficiary as a proxy of death.Methods We used 510,751,798 monthly beneficiary records between April 2007 and March 2017 from the LTCI registry, while excluding data for ineligible persons for LTCI benefit or those younger than 65 years. We identified insurer cases disqualified from LTCI beneficiaries and linked them to national death records using deterministic linkage methods by dates of birth and death, sex, and residence. We considered the cases as positive if they were disqualified and their record was linked to a death. We used sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as validity indices.Results We identified 5,986,991 (1.17%) disqualified and 5,295,961 death cases. Sensitivity, specificity, PPV, and NPV of disqualification for death were 100%, 99.86%, 88.46%, and 100%, respectively. After stratification, PPV of disqualification was between 85% and 88% before 2012, 91% after 2012, 91.9% in men, and 85.9% in women. PPV increased with age (65-69 years: 80.6%, 70-74 years: 86.7%, 75-79 years: 86.4%, 80-84 years: 86.7%, 85-89 years: 88.0%, 90-94 years: 90.6%, and 95+ years: 93.4%) and level of care needed (support level: 72.2%, care level (CL) 1: 79.7%, CL2: 85.9%, CL3: 89.3%, CL4: 92.3%, and CL5: 94.0%).Conclusions Disqualification from the LTCI registry is an inappropriate measure to estimate mortality accurately because it has a 10% false-positive rate. However, it appears sufficiently valid to use disqualification as a proxy outcome of death, although the main effect or confounding of a possible predictor of death could be slightly underestimated.

Municipal Characteristics of In-Home Death Among Care-Dependent Older Japanese Adults

The provision of in-home and community end-of-life care has emerged as an important policy issue for aging populations around the world. Despite most patients expressing the wish to die at home (as opposed to in the hospital), substantial geographic variation persists in the prevalence of in-home death at the end of life. To assess the association of municipal characteristics with variation in the place of death among care-dependent older people in Japan. In this cross-sectional study using multilevel logistic regression, analyses were performed using national claims data under Japan's long-term care insurance system. The study population included long-term care insurance beneficiaries 65 years and older who died in 2015, excluding those who died from external causes, such as unintentional injuries. Data analyses were conducted from January 1 to April 31, 2021. Predisposing, enabling, and need factors at the individual and municipal levels according to a behavioral model. The outcome was whether individuals died at home or not. This cross-sectional study analyzed 544 836 decedents (median [IQR] age, 87 [81-91] years; 300 142 [55.1%] female). The proportion of in-home deaths was 10.3%. In the multilevel null model, 7.2% of the variance in the place of death was associated with municipal-level characteristics. Municipal characteristics were associated with more of the variance than were prefectural characteristics (2.7%). The largest proportional change (7.3%) in variance at the municipality level was observed when enabling factors (ie, medical and long-term care resources) were added to the model. Municipalities with a high proportion of in-home death were more likely to have a higher supply of clinics, physicians, and care workers providing in-home services per population, as well as a lower number of hospital beds and long-term care facility workers per population. In this cross-sectional study, municipal characteristics explained a substantial proportion of the geographic variance in in-home death in Japan. These results suggest that municipal policy makers need to ensure an adequate supply of clinics, physicians, and care workers providing in-home services to meet the preferences of care-dependent older people who wish to spend their final days at home.

Comparison of Medical Utilization and Drug Prescription Patterns of Long-term Care Insurance Beneficiaries and Non-beneficiaries

Older adults who receive long-term care (LTC) services are expected to differ from older adults who do not receive such services. These differences are expected in healthcare utilization and drug prescription, as older adults in LTC services, have more difficulty in daily life. This study aimed to compare the differences in healthcare utilization and drug prescription between LTC beneficiaries and those who do not receive LTC services. Using the senior cohort from the National Health Insurance Service, LTC beneficiaries and non-beneficiaries were defined, and their patterns of healthcare utilization and drug prescription were analyzed for the year 2015. The total number of participants in the study was 239,873, and the number of LTC beneficiaries was 20,619 (8.6%). For LTC beneficiaries, the average number of hospitalizations per year was two, total hospitalization days 70, and the number of outpatient visits per year 28.8, and for non-beneficiaries, these were 1.7, 49, and 34.9, respectively. LTC beneficiaries had more frequent hospitalizations, longer hospital stays, and fewer outpatient visits. In terms of drug prescription for LTC beneficiaries, the average number of prescription days was 280, the number of the daily pills was 4.7, and total prescription days per year per prescription were 22.9, and for nonbeneficiaries, these were 277, 3.8, and 18.1, respectively. LTC beneficiaries took more daily pills and had longer prescriptions than non-beneficiaries. LTC beneficiaries showed differences in healthcare utilization and drug prescription patterns in comparison to non-beneficiaries. Further research based on the characteristics of LTC beneficiaries is needed.

Association of the Frequency of In-Home Care Services Utilization and the Probability of In-Home Death

The provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life. To assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life. This cohort study of older adults in Japan's long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020. Mean days of in-home care service used per week from the first day of the month before the month of death to the date of death. Primary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014. Of the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points). This retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.

Cost of Care and Pattern of Medical Care Use in the Last Year of Life among Long-Term Care Insurance Beneficiaries in South Korea: Using National Claims Data.

In Korea, a substantial proportion of long-term care insurance (LTCI) beneficiaries die within 1 year of seeking the benefit. This study was conducted to evaluate the pattern of medical care use and care cost during the last year of life among Korean LTCI beneficiaries between 2009 and 2013 using the national claims data. The National Health Insurance’s Senior (NHIS-Senior) cohort was used for this retrospective study. The participants were LTCI beneficiaries aged 65 or over as of 2008 who died between 2009 and 2013 (N = 30,433). Medical costs during the last year of life were highest for those who used both medical care services and long-term care (LTC) services and increased as death approached. About half of the participants were hospitalized at the time of death. The use of LTC services at the time of death increased from 13.0 to 22.8%, while those who died at home decreased from 34 to 20%. This study suggests that the use of LTC services did not reduce medical costs by substituting unnecessary inpatient hospitalization. Quality of dying should be considered one of the goals of older adult care, and provisions should be made for palliative care at home or LTC facilities.

Disagreement between a public insurer’s recommendation and beneficiary’s choice of long-term care services in Korea

This study examined the disagreement between an insurer’s recommendation for long-term care (LTC) services and beneficiaries’ choices and analyzed the factors associated with the disagreement. Data from the National Long-Term Care Insurance (LTCI) and the Standard Care Plan were merged to create a dataset of 43,319 LTCI beneficiaries. The dependent variable was the disagreement between beneficiaries and insurers. Predisposing, enabling, and needs factors were independent variables based on the Andersen’s Model. Disagreement between the insurer’s recommendation of home care services and the beneficiaries’ choice of institution service was 6.7% (n = 2357). The opposite disagreement occurred in 23.0% (n = 1820) of cases. A multivariate analysis showed that the OR for disagreement between insurer-recommended home care services and beneficiary-selected institution services increased with age, living with someone, having Medical Aid, living in a facility, and having high care needs, dementia, and poor subjective hearing. The OR for disagreement between insurer-recommended institution service and beneficiary-selected home care service increased for men and decreased for those 90 years or older, living with someone, having Medicaid etc, and living at institution. Korean beneficiaries of LTCI have a high preference for aging in their home, and changes in LTCI contents must be made to address the needs of this population.

Potentially Avoidable Hospitalization among Long-Term Care Insurance Beneficiaries with Dementia.

BackgroundThis study investigated the differences in the risk of potentially avoidable hospitalization (PAH) among eligible long-term care insurance (LTCI) beneficiaries with dementia for LTCI services in Korea. Nested case-control study was conducted using the National Health Insurance Service–Senior claim database.MethodsCases of individuals who had a PAH incident diagnosis and controls were selected by incidence density sampling and matched to cases based on age, sex, and difficulty of daily living among dementia patients. We conducted incidence density sampling three times by PAH type.ResultsOur main results were presented by conditional logistic regression analysis for the matched case–control studies. Out of the 7,352 eligible LTCI beneficiary patients, there were 1,231 cases (16.7%) in overall PAH, 132 cases (19.0%) in acute PAH and 1,114 cases (16.7%) in chronic PAH categories. In terms of individual risk of overall and chronic PAH, the odds ratios of those who did not receive any services were 1.336 time higher (95% confidence interval [CI], 1.159–1.540) and 1.280 time higher (95% CI, 1.103–1.485) compared to those who received home care, respectively. For risk of acute PAH, the odds ratios of those who did receive institutional care were 2.046 time higher (95% CI, 1.170–3.578) compared to those who received home care.ConclusionThis study identified the differences in risk of PAH incidents according to the type of LTCI service in the elderly population in Korea. Therefore, it will require substantial effort and strategy from health policy makers to improve care quality.

Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services

BackgroundHip fracture among older adults is not only a major health issue but also preventable by providing proper care, but there is a lack of studies on the association between type of long-term care (LTC) service and hip fracture. This study aimed to investigate the association between the type of LTC service and the incidence of hip fracture among older adults with dementia receiving long-term care insurance (LTCI), and to investigate how such association differs according to characteristics of beneficiaries and structural characteristic of institutional care.MethodIn this retrospective cohort study, data from 2008 to 2013 were collected from 7112 LTCI beneficiaries having benefit level 1 or 2 with dementia aged 60 years or over in the Korean elderly cohort data set. Type of LTC service was categorized into institutional or home care using the LTCI Claims Database, and the incidence of hip fracture was used as the outcome variable. A survival analysis using a time-dependent Cox regression analysis was performed to examine the association between time-varying LTC service type and hip fracture.ResultsOf the 7112 older adults, 115 (1.6%) had hip fracture during a total of 16,540 person-years. Compared to LTC beneficiaries with home care, those with institutional care had a higher adjusted hazards ratio of incidence of hip fracture (hazards ratio = 4.33, 95% confidence interval, 2.84–6.59). This association was particularly strong among beneficiaries who did not have a danger of hip fracture during the mandatory assessment for benefit eligibility, who were partially ambulatory, who were from rural areas, and females.ConclusionsInstitutional care was more likely associated with a higher incidence of hip fracture than home care. The government need to watch the institutional LTC services quality and promote improvements of the institutional care quality.

Status and Trend of Home Health Nursing for Long-Term Care Insurance Beneficiaries

Status and Trend of Home Health Nursing for Long-Term Care Insurance Beneficiaries

Does long-term care insurance reduce the burden of medical costs? A retrospective elderly cohort study.

To examine whether long-term care insurance (LTCI) reduces medical utilization and the burden of medical costs of beneficiaries. The elderly cohort database of the National Health Insurance Service during 2005-2013 was used. The participants were 3029 beneficiaries who received consecutive LTCI services. We carried out a 1:3 case-control match on the propensity score to select a comparison group, and the final participants were 12 116 people, including 9087 who formed the control group. The dependent variables were semi-annually measured medical utilizations (inpatient, outpatient and drug prescription) and the burden of medical costs at the individual level. This study applied the method of generalized estimating equations to the data. The present study showed that the number of hospitalizations of beneficiaries significantly decreased compared with non-beneficiaries (ratio 0.95, 95% CI 0.95-0.96). Similarly, the length of stay of beneficiaries also showed a significant reduction compared with non-beneficiaries (ratio 0.76, 95% CI 0.73-0.79). The number of outpatient visits and receipt of drug prescriptions of beneficiaries and non-beneficiaries increased marginally. The burden of medical costs of beneficiaries reduced considerably compared with non-beneficiaries (ratio 0.80, 95% CI 0.77-0.83). The study results show that the burden of medical costs for LTCI beneficiaries were significantly reduced compared with non-beneficiaries, despite the rise in medical costs among older adults. The positive effect of LTCI supports continuous implementation and expansion of the LTCI service for non-beneficiaries who require care assistance. Geriatr Gerontol Int 2018; 18: 1641-1646.

Association between home-visit nursing utilization and all-cause hospitalization among long-term care insurance beneficiaries: A retrospective cohort study

BackgroundEnsuring and improving long-term care services that use limited healthcare resources more efficiently is a major concern for many aging societies. ObjectivesThe aim of this study was to investigate the relationship between use of home-visit nursing services and all-cause hospitalization in a home-visit nursing-recommended group. DesignA retrospective cohort study. SettingPopulation-based sample of long-term care insurance beneficiaries from the long-term care insurance 2002–2013 claims database in South Korea. ParticipantsLong-term care insurance beneficiaries who need one or more types of nursing care were defined as the home-visit nursing −recommended group (n=4173). MeasurementsThe dependent variable in this study was all-cause hospitalization in the home-visit nursing-recommended population. Multivariate Cox proportional hazards regression analysis was used to identify the association between home-visit nursing service use and all-cause hospitalization. ResultsA total of 3.8% of the subjects used home-visit nursing services. When participants who used home-visit nursing services were set as the reference group, participants who did not use home-visit nursing services had a higher risk of hospitalization (hazard ratio [HR]=1.25, 95% confidence interval [CI]=1.07–1.47). Additionally, participants who did not use home-visit nursing services and who did not have a caregiver showed a marked increase in the risk of hospitalization (HR=6.81, 95% CI=1.17–39.66). Participants who did not use home-visit nursing services with greater comorbidity showed a considerable increase in risk of hospitalization (HR=1.36, 95% CI=1.09–1.70). ConclusionsNon-use of home-visit nursing services was associated with an increased risk of all-cause hospitalization in the home-visit nursing-recommended population. The present results suggest that the use of home-visit nursing services reduced the risk of hospitalization. Moreover, home-visit nursing may play an essential role in reducing hospitalization risk in the absence of caregiver support.

Effects of home-visit nursing services on hospitalization in the elderly with pressure ulcers: a longitudinal study

The risk of pressure ulcers in beneficiaries of long-term care insurance is expected to increase in South Korea's aging society. However, those who stay at home may not be managed appropriately with regard to pressure ulcer development. Here, we examined the relationship between home-visit nursing services and hospitalization related to pressure ulcers among beneficiaries with pressure ulcers in home-care settings. We analyzed National Aging Cohort data from 2008 to 2013. The study population was defined as those who required nursing care for pressure ulcers and received home-care services at least once under long-term care insurance. Logistic regression analysis using generalized estimating equation models was performed to examine the association between home-visit nursing services and hospitalization related to pressure ulcers. Among 4,807 beneficiaries with pressure ulcers, 859 (17.9%) were admitted to hospitals during the study period. The use of home-visit nursing services was associated significantly with a lower risk of hospitalization (odds ratio = 0.68, 95% confidence interval = 0.49-0.93; reference, no use). This association was especially strong in beneficiaries with mildly impaired mobility and cognitive function. Given the protective role of home-visit nursing services in the management of long-term care insurance beneficiaries with pressure ulcers who stay at home, healthcare professionals need to consider effective strategies for the activation of home-visit nursing services in South Korea.

Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort

ObjectiveTo assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI). MethodsData from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (n = 7841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model. ResultsOf the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48–10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory. DiscussionBeneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care.

Improving the Cooperation Rate of Older Adults and Their Caregivers in Research Surveys

Background: Recruiting older adults, their family members and their home care workers as participants in research studies is particularly complicated. This might be due to medical or cognitive problems of the older adult as well as the high workload and shortage of time experienced by caregivers. The present study compared the contribution of two different versions of an advanced letter followed by two different versions of a recruitment phone call to the cooperation rate of older adults, family caregivers and home care workers in a face-to-face survey. Methods: A quasi-experimental design was used to compare the contribution of the different types of appeal. A total of 2,014 caregiving units (composed of an older adult, a family member and a home care worker) were randomly sampled from a list of Israeli long-term care insurance beneficiaries. 74.32% of the sampled caregiving units were eligible to participate in the study. The first group of participants received formal and succinctly phrased written and oral appeals - an advanced letter followed by a recruitment phone call. The second group of participants received the original formal and succinctly phrased advanced letter, but a revised recruitment phone call that included a more personal approach, the provision of broader information about the study and the avoidance of words with a possible negative connotation. The third group of participants received both a revised advanced letter and a revised recruitment phone call. Results: Using the succinctly phrased written and oral appeals, we had a cooperation rate of about 50% for the entire caregiving unit. Using a revised advanced letter and a revised recruitment phone call yielded an increase of 20-25% in the cooperation rate for the entire caregiving unit. Using the revised recruitment phone call and the original advanced letter yielded an increase in the cooperation rate only among migrant home care workers. Conclusion: This study showed that by changing the format of appeal we can increase the cooperation rate of older adults and their caregivers in a research survey. This study also pointed out the importance of the advanced letter.

Entwicklung der Leistungsempfängerzahlen in der Gesetzlichen Pflegeversicherung – Zum Einfluss unterschiedlicher Morbiditätsannahmen auf die Entwicklung der sozialrechtlich anerkannten Pflegebedürftigkeit in Deutschland

Abstract Demographic change in Germany will lead to a higher number of people in need of long-term care and an increasing demand for Long-term Care Insurance (LTCI) services. While the general rise in beneficiaries is not controversial, there is uncertainty about the magnitude of change, which also depends on the development of morbidity patterns. Simulations show that the number of LTCI beneficiaries is likely to double through 2080 if age- and sex-specific prevalence rates are held constant; following this scenario, life expectancy spend in long-term care is going to rise in absolute as well as relative terms. Even in scenarios simulating a compression of need for long-term care a general increase in the number of beneficiaries is unavoidable. Beside the number of LTCI beneficiaries other factors like the number of informal caregivers or the adjustment of LTCI benefit levels also influence the financial development of LTCI. Zusammenfassung Die Bevolkerungsentwicklung in Deutschland wird zu einer zukunft...