Long-term Care Insurance Services 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...

Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic has impacted peoples’ health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services.MethodsIn this study, we used anonymized data from “Kaipoke,” a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable.ResultsThe participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD − 1668.8 in adult day care.ConclusionThe decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

The medical treatment needs and in-home care service utilization of the elderly: a population-based data analysis of long-term care insurance payments in Tokyo, Japan

How can we improve in-home care for the elderly with medical treatment needs? The purpose of this study is to investigate medical treatment and examine the use of home care services. We analyzed the long-term care insurance service payments data in City A (n=18,882) as of January 2019 and checked 12 medical treatment care needs items. The results showed that 10.1% (1913 of a total of 18,882) of people required medical treatment. The analysis was carried out by using a filter, “living in home” (n=15,320). We focused on urinary catheter and tube feeding. The study subjects are categorized into three groups: group 1 [both tubes (n=61)], group 2 [either tube (n=564)], and group 3 [no tube (n=14,698)]. The home help utilization rate was 27.9% in group 1, 29.9% in group 2, and 20.5% in group 3 (p<0.01). The home visit nursing utilization rate was 11.5% in group 1, 23.7% in group 2, and 8.1% in group 3 (p<0.01).

Chronic pain in older adults with disabilities is associated with fall-related injuries: a prospective cohort study.

Previous studies have shown an association between chronic pain and the occurrence of falls in community-dwelling older adults; however, the association between chronic pain and fall-related injuries in older adults with disabilities is unclear. This study aimed to determine the association between chronic pain and fall-related injuries in older adults with disabilities. This 24-month prospective cohort study included older adults aged 65years or older using Japanese long-term care insurance services. Chronic pain, defined as "pain that has persisted for more than three months to date," was assessed using a face-to-face questionnaire. Fall-related injuries, defined as "injuries requiring hospitalization or outpatient treatment due to a fall," were assessed using a fall calendar. Data were analyzed using a Cox proportional hazards model, with fall-related injury as the dependent variable, chronic pain as the independent variable, and confounders as covariates. Among 133 included participants, 15 experienced fall-related injuries. After adjusting for age and sex as covariates, chronic pain was significantly associated with fall-related injuries (hazard ratio: 5.487, 95% confidence interval: 1.211-24.853, p = 0.027). Chronic pain was associated with fall-related injuries in older adults with disabilities. In this population, a greater focus should be placed on treating chronic pain to reduce the occurrence of falls.

Current Status of Public Long-term Care Insurance Services and Future Perspective: A Questionnaire Survey and National Health Insurance Service Data of South Korea

The continuing growth of population aged 65 years and above, the socioeconomic burden of long-term care insurance has consistently increased. This study aimed to review the current system and efficiently develop long-term care insurance services according to changes in socioeconomic situations. First, a 21 items questionnaire survey was conducted from August 16 to August 31, 2022, for all members of the Korean Neurological Association. The survey was divided into seven areas, and individualized results were analyzed. Second, cumulative data on long-term care insurance services were collected and analyzed from July 1, 2008 to December 31, 2021, for the National Health Insurance system, and the results were summarized. In the survey, approximately 21% of the neurologists answered a web-based questionnaire survey on current doctors’ referral slips for long-term insurance services. Most (94%) had doctor referral slips for long-term insurance services. However, the authors estimated that doctors’ referral slips did not sufficiently affect the grading of longterm insurance services. The long-term care insurance services data according to several categories were classified and then, we statistically analyzed the socioeconomic burden of long-term insurance. Those cumulative data showed a gradual increase in the recipient number, diversity of geriatric diseases, and socioeconomic burden. We suggested that it is necessary for the government and academic society to continue to cooperate to develop the long-term care insurance systems for elderly.

Effective service coverage of long-term care among older persons in South Korea.

Global population aging, and the accelerated increase in the number of oldest-old adults, over 80years, has implied a heightened need for long-term care (LTC). We aimed to provide a theoretical care cascade of LTC services to assess publicly funded LTC (Analysis 1) and to investigate the association between the use of LTC insurance (LTCI) and unmet care needs among older people (Analysis 2) in South Korea. Analysis 1 used data from the eighth wave (2020) of the Korean Longitudinal Study of Aging (KLoSA), the 2020 National Health Insurance Service LTCI Statistical YearBook and the 2020 National Awareness Survey of LTCI. The care cascade consisted of the target population, service contacts, coverage and outcomes. Analysis 2 used the fifth to eighth waves of KLoSA, and LTCI analysis was based on three groups: not aware, aware but do not use and aware and use. Unmet care needs were defined as the absence of help among older people with care needs. Among 8,489,208 people aged 65 or older in 2020, 1,368,148 (16.1%) were estimated to want care. Of these, 62.7% (N = 857,984) had LTCI service contact and 807,067 (94.1%) of those had used LTCI services in the past year (Analysis 1). Older people who were aware and used LTCI were less likely to report unmet activities of daily living (ADL) (prevalence ratio (PR): 0.34, 95% confidence interval (CI): 0.18-0.66) or unmet instrumental ADL (IADL) needs (PR: 0.27, 95% CI: 0.17-0.43) than those who were not aware (Analysis 2). This article provides a theoretical cascade to assess LTC provision in South Korea and a preliminary model for other countries. Korea's LTCI is associated with reduced unmet ADL and IADL needs.

Facility staffing associated with potentially avoidable hospitalizations in nursing home residents in Japan: a retrospective cohort study

BackgroundWide variations in facility staffing may lead to differences in care, and consequently, adverse outcomes such as hospitalizations. However, few studies focused on types of occupations. Therefore, we aimed to examine the association between a wide variety of facility staffing and potentially avoidable hospitalizations of nursing home residents in Japan.MethodsIn this retrospective cohort study using long-term care and medical insurance claims data in Ibaraki Prefecture from April 2018 to March 2019, we identified individuals aged 65 years and above who were newly admitted to nursing homes. In addition, facility characteristic data were obtained from the long-term care insurance service disclosure system. Subsequently, we conducted a multivariable Cox regression analysis and evaluated the association between facility staffing and potentially avoidable hospitalizations.ResultsA total of 2909 residents from 235 nursing homes were included. The cumulative incidence of potentially avoidable hospitalizations at 180 days was 14.2% (95% confidence interval [CI] 12.7–15.8). Facilities with full-time physicians (adjusted hazard ratio [HR]: 0.59, 95% CI: 0.37–0.94) and a higher number of dietitians (HR: 0.72, 95% CI: 0.54–0.97) were significantly associated with a lower likelihood of potentially avoidable hospitalizations. In contrast, having nurses or trained caregivers during the night shift (HR: 1.72, 95% CI: 1.25–2.36) and a higher number of care managers (HR: 1.37, 95% CI: 1.03–1.83) were significantly associated with a high probability of potentially avoidable hospitalizations.ConclusionsWe revealed that variations in facility staffing were associated with potentially avoidable hospitalizations. The results suggest that optimal allocation of human resources, such as dietitians and physicians, may be essential to reduce potentially avoidable hospitalizations. To provide appropriate care to nursing home residents, it is necessary to establish a system to effectively allocate limited resources. Further research is warranted on the causal relationship between staff allocation and unnecessary hospitalizations, considering the confounding factors.

Exploratory study on the factors related with the early detection of missing older persons with dementia living alone in Japan.

To clarify the factors related to the early detection of missing older persons with dementia (PwD) who lived alone in Japan. We carried out a multiple regression analysis with data from 88 missing PwD. The location of the discovery was within the municipality where the missing PwD lived. Furthermore, the use of long-term care insurance services was significantly associated with early detection. Missing PwD were located within the municipality in which they lived, which meant that the individual was found before they went far. In addition, with the long-term care insurance services, professionals should regularly visit the home of PwD according to a care plan. Planned regular visits might trigger the early recognition of a missing person with dementia and enable early search activities. Therefore, use of long-term care insurance services might lead to the early detection of missing PwD living alone. Geriatr Gerontol Int 2023; 23: 362-365.

How the 2018 Japan Floods Impacted Nursing Home Admissions for Older Persons: A Longitudinal Study Using the Long-Term Care Insurance Comprehensive Database.

As disasters become more frequent because of global warming, countries across the world are seeking ways to protect vulnerable older populations. Although these conditions may increase nursing home admission (NHA) rates for older persons, we know of no studies that have directly tested this hypothesis. This was a retrospective cohort study. We analyzed data from long-term care insurance (LTCI) users in 3 Japanese prefectures that incurred heavy damage from the 2018 Japan Floods, which is the largest recorded flooding disaster in national history. Specifically, we extracted NHA data from the LTCI comprehensive database, both for disaster-affected and unaffected individuals. We employed the Cox proportional hazards model to calculate multivariate-adjusted hazard ratios (HRs) for NHAs within a 6-month period following the 2018 Japan Floods, with adjustments for potential confounding factors. Of the 187,861 individuals who used LTCI services during the investigated period, we identified 2156 (1.1%) as disaster affected. The HR for NHA was significantly higher for disaster-affected (vs unaffected) individuals (adjusted HR 3.23: 95% CI 2.88‒3.64), and also higher than the HRs for older age (90-94years vs 65-69years: 2.29, CI 1.93‒2.70), cognitive impairment (severe impairment vs normal: 1.40, CI 1.25‒1.57), and physical function (bedridden vs independent: 2.27, CI 1.83‒2.70). According to our subgroup analyses, the adjusted HR for disaster-affected individuals unable to feed themselves was 6.00 (CI 3.68‒9.79), with a significant interaction between the 2 variables (P= .01). Natural disasters increase the risk of NHA for older persons, especially those who are unable to feed themselves. Health care providers and policymakers should understand and prepare for this emerging risk factor.

Identifying and Characterizing People with Dementia not Accessing the Japanese Community-Based Integrated Care System using Health Insurance Claims Data.

Objectives In the Japanese Community-Based Integrated Care System (CBICS), access to formal care services is based on voluntary consultations mainly from the families of people with dementia (PWD). The problem is that some people need services but do not consult their municipalities for various reasons. The purpose of this study is to examine the possibility of using health insurance claims data to identify and characterize these PWD. Methods Using health insurance claims data, we selected PWD prescribed with anti-dementia drugs. Of them, excluding those with a usage history of long-term care insurance services or other formal services, facility residents and deaths, we identified PWD not accessing the CBICS. We conducted a visit survey on their status, home care environment and reasons for not accessing services, a proposal for using services and a one-year follow-up. Result Based on the data of 1,809 late-stage elderly who resided in the Tamaki-cho, a town in Mie Prefecture, Japan, for a 2-month period, 16 PWD not accessing the CBICS were identified, and 15 PWD and their families participated in this study. Ten were men and 13 were physically and cognitively relatively independent. All lived with a family caregiver and refused services. Ten families needed but had not accessed the services due to refusal by PWD and other reasons. As a result, seven of these PWD started using long-term care insurance services or dementia prevention services. Conclusions PWD not accessing the CBICS can be identified using health insurance claims data. The results proved that the municipality has a cost-effective way of providing their services to PWD and their families, even if they have never consulted voluntarily.

Oral function and cumulative long-term care costs among older Japanese adults: a prospective 6-year follow-up study of long care receipt data

ObjectivesThis study evaluated the relationship between status of oral function and related long-term care service costs.DesignThis was a prospective 6-year follow-up study of previous survey data.SettingThe data were obtained from...

Association between behavioural and psychological symptoms of dementia and residence status in patients with Alzheimer's disease.

Examining the relationship between the behavioural and psychological symptoms of dementia (BPSD) and residence status is crucial to improving BPSD and reducing the burden on caregivers. However, studies on how BPSD differ between individuals living at home and those in institutional settings are lacking. We conducted a questionnaire survey among healthcare providers (HCPs) involved in dementia care and nursing to clarify the characteristics of BPSD by residence status in patients with Alzheimer's disease (AD) living at home or in facilities. We sent questionnaires to HCPs and asked them to answer questions on up to five cases that needed treatment for BPSD and who received long-term care insurance services from 1 April 2016 to 31 March 2017. Responses were received for 371 cases, of which 130 diagnosed with AD were analyzed. The patients were divided into two groups: patients with AD living at home (home care group) and patients with AD living in facilities (facility care group). A Chi-square test was used to identify differences between the two groups. A binomial logistic regression analysis was also conducted to clarify the association between residence status and BPSD. Of the 130 patients, 72 lived at home (home care group) and 58 resided in facilities (facility care group). None of the background factors was significantly different between the two groups. The Chi-square test indicated that sleep disturbance was significantly more common in the facility care group (60.3% in the facility care group vs. 33.3% in the home care group, P=0.003), while the logistic regression analysis indicated that sleep disturbance was significantly associated with residence status (odds ratio: 2.529, P=0.038). Sleep disturbances were more frequently observed among patients with AD living in institutions than among those living in their homes.

한국 노인의 장기요양 서비스 이용과 삶의 질에 관련된 학술논문 체계적 문헌 고찰

As the numbers of elderly people are rapidly increasing, long-term care insurance, introduced to elevating the quality of life of the elderly and relieve the burden of their families’ support, has been in existence for 15 years. The purpose of this study was to build a theoretical foundation for elevating the quality of life of the elderly, by systematically synthesizing empirical studies on the quality of life of the elderly using long-term care services. In this study, 1,797 documents were searched by combining keywords such as <Long-Term Care Insurance Service> and <Quality of Life> in three web databases of KCI, RISS, and e-articles published July 1, 2008-April 1, 2022. The final 30 documents were selected and analyzed, by applying the inclusion and exclusion criteria to the literature. As a result, first, it was feasible to categorize variables related to long-term care services into three factors (institutional, service, and individual factors). Second, it was confirmed that the quality of life of the elderly was directly or indirectly impacted by service satisfaction, as well as individual factors, in addition to institutional factors. Third, it was found that the quality of life of the elderly was significantly related to demographic characteristics as well as physical function, subjective health status, emotional/ psychological, and social function. Based on the results, practical and policy recommendations and follow-up research directions are suggested, to improve the quality of life of the elderly using long-term care services.

Psychological distress in sons as resident carers of older mothers in Japan

AbstractIn Japan, care-giving sons are noted for their high rates of abuse of care recipients. This study revealed, for the first time, the difficulties unique to sons caring for their mothers. All sons used long-term care insurance services. However, they provided care that could not be covered by such public services while harbouring psychological distress. In this study, we interviewed 13 sons living with their older mothers as the primary carer and conducted a thematic analysis focusing on their psychological distress. As part of our study findings, we have identified nine themes during analysis: uncomfortable feelings that cannot be mitigated as a son; feeling of futility in being unrecognised as a carer; fear of losing something important; a strong sense of responsibility for one's mother's life; disappointment in being unable to obtain understanding and co-operation from one's siblings in providing care; irritation and anger towards one's wayward mother; guilt about treatment of one's mother; sense of exhaustion due to demanding care; and experiencing hopelessness and despair. Thus, it is important to understand what psychological distress carers experience and to consider possible approaches for their support. The study findings provide suggestions for long-term care support in regions, such as East Asia, where the numbers of son carers are increasing inevitably owing to declining birth rates and ageing population, as in Japan.

한국과 일본의 노인장기요양보험제도에 관한 비교연구: 자치단체의 관점에서

Japan is the best case study of a low-fertility and aged society in Korea, and the fundamental purpose of this study is to find clues in Japan to overcome Korea's low-fertility and aged society. Therefore, the researcher evaluates and analyzes the various social policy that Japan has taken for the aging society, and intends to find our social welfare policy for the elderly from there. In the analysis, the researcher basically stood in the position of new institutionalism, identified the policy's historicity, path dependency, and value orientation. Gilbert and Terrel used more practical for using spectrum not dichotomy. Their policy analysis breaks away from the dichotomous approach of the existing universalist value and the selective approach, and places selectivism and universalism as two extremes so that they can analyze more realistic aspects, and set their position on one spectrum. Research also use this analysis tool because It is a very realistic policy analysis method to analyze whether between two counties, Korea and Japan are differenciated with each other or not. Researcher intends to reveal the characteristics of the welfare states of Korea and Japan. The analysis includes selection of values for policy making, and the policies used in the analysis include not only long-term care insurance (LTC) but also social services for the elderly for a low-fertility and aging society. Through the analysis so far, the researcher confirmed the fact that Korea and Japan, which belong to the same type of welfare state, especially Long-term care insurance and social services for the elderly between the two countries. They are clearly divided into more selective perspectives in Korea and more universalistic perspectives in Japan. Finally, I would like to conclude by suggesting and writing about the establishment of a regional integrated care system that Japan is promoting as a measure for a low-fertility and aging society.

Long-Term Care Insurance and Medical Services for the Elderly: The Role of the Healthcare Industry

The long-term care insurance for the elderly system was officially implemented in July 2008, following a 3-year pilot program starting in 2005. The purpose of this system was to improve the quality of life of seniors and reduce the burden of care among family members, given the growing elderly population. By 2021, the scale of the system had increased by two to four times, with 860,000 beneficiaries and 9,824,800,000,000 KRW worth of insurance benefits. In line with this increase, it is necessary to efficiently establish and improve the system so that it can directly meet the medical needs of the beneficiaries. This may serve to reduce the rapidly increasing expenditure related to the elderly medical expenses, which in turn leads to a decrease in societal costs. In conclusion, senior care needs to be properly established and implemented in order to create organic intra- and inter-field connections between medicine, healthcare, and welfare.

Changes in long-term care certification rate and related factors in municipalities affected by the heavy rain disaster in July 2018

Objectives The purpose of this study was to determine the change in the certification rate for long-term care (LTC) in the municipalities affected by the heavy rain disaster in July 2018, and to clarify the relationships between the change in the LTC certification rate and the damage situation and regional characteristics.Methods The subjects were 108 municipalities to which the Disaster Relief Act was applied. Interrupted time series analyses were conducted of the monthly LTC certification rate for a total of 37 months from July 2016 to July 2019, and the changes in the LTC, mild LTC (requiring support 1 and 2), moderate LTC (requiring long-term care 1 to 3), and severe LTC (requiring long-term care 4 and 5) certification rates after the disaster were determined. Multinomial logistic regression analyses were performed to clarify the relationship between trends of changes in the LTC certification rate after the disaster, the damage situation (number of damaged houses, number of dead and missing), and the regional characteristics (population rate of people aged 65 and over, population density, taxable income, population per public health nurse, capacity of long-term care insurance facilities, number of hospital beds, number of clinics, specific health examination implementation rate, and specific health guidance implementation rate).Results The LTC and mild LTC certification rates showed significant increases in the month of the disaster and changes in trends after the disaster. The change in the post-disaster trend of the moderate LTC certification rate was significantly lower. The severe LTC certification rate showed a significant increase only in the month of the disaster; however, there was no significant change seen in the post-disaster trend. The downward change in the trend of the moderate LTC certification rate was negatively related to the population rate of people aged 65 and over, and positively related to the number of clinics. No significant associations of the LTC, mild LTC, and severe LTC certification rates with any of the variables related to the disaster situation and regional characteristics were found.Conclusion The results of this study suggest that the demand for long-term care insurance services may increase as a result of disasters experienced by elderly requiring mild LTC certification who have a relatively high degree of independence.

Effects of the\xa02018 Japan Floods on long-term care insurance costs in Japan: retrospective cohort study

BackgroundClimate change has increased the frequency and severity of torrential rains and floods around the world. Estimating the costs of these disasters is one of the five global research priorities identified by WHO. The 2018 Japan Floods hit western Japan causing extensive destruction and many deaths, especially among vulnerable elderly. Such affected elderly would need long-term care due to the various health problems caused by the disaster. A Long-Term Care Insurance (LTCI) system provides care services in Japan. The aim of this study was to evaluate the effect of the 2018 Japan Floods on LTCI costs and service utilization.MethodsThe participants of this retrospective cohort study were all verified persons utilizing LTCI services in Hiroshima, Okayama and Ehime prefectures. The observation period was from 2 months before to 6 months after the disaster. We used Generalized Estimating Equations (GEEs) to examine the association between disaster status (victims or non-victims) and the monthly total costs of LTCI service (with gamma-distribution/log-link) by residential environment (home or facility). Among home residents, we also examined each service utilization (home-based service, short-stay service and facility service), using the GEEs. After the GEEs, we estimated Average Marginal Effects (AME) over all observation periods by months as the attributable disaster effect.ResultsThe total number of participants was 279,578. There were 3024 flood victims. The disaster was associated with significantly higher total costs. The AME for home residents at 2 months after was $214 (Standard Error (SE): 12, p < 0.001), which was the highest through the observation period. Among facility residents, the AME immediately after the disaster increased by up to $850 (SE: 29, p < 0.001). The service utilization among home residents showed a different trend for each service. The AME of home-based services decreased by up to − 15.2% (SE:1.3, p < 0.001). The AME for short-stay service increased by up to 8.2% (SE: 0.9, p < 0.001) and the AME for facility service increased by up to 7.4% (SE: 0.7, p < 0.001), respectively.ConclusionsThe 2018 Japan Floods caused an increase in LTCI costs and the utilization of short-stay and facility services, and a decrease in utilization of home-based services.

介護保険サービス限度額内で通所リハビリテーションの利用が難しい外来維持期リハビリテーション患者の実態と特性

介護保険サービス限度額内で通所リハビリテーションの利用が難しい外来維持期リハビリテーション患者の実態と特性

Practices and issues in home health care and other long-term care insurance services.

Practices and issues in home health care and other long-term care insurance services.