Use Of Long-term Care Services Research Articles

Use of Long-Term Care Services by Older Persons with Limited English Proficiency

ABSTRACT Older migrants face special difficulties in the access and use of long-term care services and supports (LTSS). Our study was designed to examine how older persons with limited English proficiency (LEP) in two groups of migrants (Spanish or Chinese speaking) interact with the LTSS system. Focus groups were used to elicit information from members of these groups. We discovered Chinese elders were likely to believe that the LTSS services could, if managed properly, meet their needs, while the Spanish speakers were more skeptical. These differences were associated with the presence of trusted intermediaries among the Chinese elders who could represent their interests, while most Spanish speakers did not report having such intermediaries. In this way, trust, or lack of it, was uncovered as the key element defining older adults’ interactions with the formal health and social service systems. Findings will be used to develop a modeling method that will allow us to analyze results in a manner that can be extended to use with other migrant groups.

Patterns of long-term care service use and multimorbidity in older Japanese adults: A cross-sectional study of claim data.

The long-term care (LTC) insurance system provides a combination of several services in Japan; therefore, it is important to clarify service utilization. Furthermore, it is important to consider multimorbidity among older adults, who frequently present several diseases. This study aimed to clarify LTC service utilization patterns, including those for newly added multifunctional services, and to describe the basic characteristics, including multimorbidity, of these patterns. We included 37 419 older adults in care need levels 1-5, living at home, who used LTC services in October 2017. We used LTC and medical claims data that were linked using unique identifiers from the National Health Insurance, Advanced Elderly Medical Insurance, and LTC Insurance of Shizuoka Prefecture in Japan. LTC service utilization patterns were identified using cluster analysis based on service fees. Multimorbidity was analyzed using the Charlson Comorbidity Index (CCI) and compared characteristics in these patterns. Six LTC service utilization patterns were identified: light use (51.0%), intensive use of day care (33.7%), intensive use of short stay (6.3%), intensive use of home help (5.1%), multifunctional LTC in small-group homes (MLS) use (3.7%), and MLS and home-visiting nurses (MLSH) use (0.2%). MLSH use had the highest CCI (3.6 ± 2.3). Intensive use of day care and short stay had the lowest CCI (2.6 ± 1.9). The characteristics of multimorbidity differed by LTC service utilization patterns. Our findings are useful for considering service utilization that takes into account the characteristics of older adults. Geriatr Gerontol Int 2024; 24: 283-289.

Association between multimorbidity and utilization of medical and long-term care among older adults in a rural mountainous area in Japan.

With the accelerated population aging, multimorbidity has become an important healthcare issue. However, few studies have examined multimorbidity and its impact on the use of medical and long-term care services in Japan. Therefore, this study aimed to examine the association between multimorbidity and the use of medical and long-term care services among older adults living in the depopulated mountainous areas of Japan. A cross-sectional study was conducted using insurance claims data from late-stage medical insurance and long-term care insurance (April 2017 to March 2018) for older adults ≥75 years residing in a mountainous area in the Tottori prefecture. In addition to the descriptive analysis, multiple generalized linear regressions with family gamma and log-link functions were used to examine the association between the number of morbidities and total annual medical and long-term care expenditures. A total of 970 participants ≥75 years were included in the analysis. Participants who had two or more morbidities constituted 86.5% of the total sample. Furthermore, participants with mental disorders were found to have more comorbidities. The number of comorbidities is associated with higher medical and long-term care expenditures. Multimorbidity was dominant among late-stage older adults living in depopulated mountainous areas of Japan, and the number of morbidities was associated with higher economic costs of medical and long-term care services. Mitigating the impact of multimorbidity among older adults in depopulated regions of Japan is an urgent challenge. Future research should investigate the degree and effectiveness of social protections for vulnerable older adults living in remote areas.

Associations between long-term care-service use and service- or care-need level progression: a nationwide cohort study using the Japanese Long-Term Care Insurance Claims database

BackgroundThe effectiveness of the long-term care service in Japan has been unclear, and most of the relevant studies of this service have been limited to a single region and relatively small samples, necessitating large-scale studies. We examined the associations between long-term care service use and the service/care-need level progression at the national scale in Japan.MethodsWe conducted a nationwide retrospective cohort study using data from the Japanese Long-Term Care Insurance Claims database. Individuals aged ≥ 65 years and newly certified as being at the support-need level 1 or 2 or the care-need level 1 between April 2012 and March 2013 were included. We first conducted 1:1 propensity score matching and then examined the associations between service use and the progression in support-need or care-need levels by using Kaplan–Meier survival curves and log-rank tests.ResultsThe final sample consisted of 332,766 individuals. We observed that service use was associated with a faster decline in the support/care-need level, although the differences in the subjects' survival rate diminished; the log-rank test showed significance (p < 0.001). When stratified for urban–rural classifications or regions of Japan, the results were similar to the primary analysis in all of the stratified groups, and no clear regional variations were observed.ConclusionWe did not observe a clear beneficial effect of receiving long-term care in Japan. Our results suggest that Japan's current long-term care service may not be effective for the recipients of these services. Considering that the system is becoming a financial burden, a re-examination of the service to provide more cost-effective care may be advisable.

An Analysis of the Effects of the Income Level of the Family Caregivers for the Recipients in Long-Term Care facilities on the Willingness to Pay for Use of Better Services: A cross-sectional study

Purpose: The purpose of this study is to confirm how the income level of the family caregivers for recipients in long-term care (LTC) facilities are related to family caregivers’ willingness to pay out-of-pocket payments for better LTC services. Methods: This study used the 2021 survey data on cost sharing in LTC facilities, which surveyed 1,111 family caregivers of recipients. To analyze the effect of the income level of family caregivers on the willingness to pay out-of-pocket payments for better LTC services, a chi-square test, a Cochran-Mantel-Haenszel test, and a logistic regression analysis were performed. Results: We found that 39.0% of respondents were willing to pay out-of-pocket payments if better services were available to recipients. Adjusted for recipient’s and family caregivers’ variables, characteristics of out-of-pocket payment, and LTC service use, the willingness to pay in the monthly household income level of 5 million won and more was 3.28 times higher than those in the monthly household income level of less than 1 million won (95% confidence level=1.93~5.55, p&lt;.001). As monthly household income rises, the odds ratio of willingness to pay tended to increase (p&lt;.001). Conclusion: Family caregivers who bear the out-of-pocket payments of LTC facilities are willing to pay more for better LTC services. In addition, the higher the income level of family caregivers, the higher their willingness to pay. A full-scale review of the system reform is needed to prevent out-of-pocket payments from becoming an economic barrier to service users and to contribute to service quality improvement and financial stability.

More long‐term care for better healthcare and vice versa: investigating the mortality effects of interactions between these public sectors

AbstractPublic healthcare (HC) and long‐term care (LTC) sectors coexist in several OECD countries. Economic interactions between these two sectors have been found to occur even in the absence of formal integrated care arrangements. We investigate whether and how interactions between the HC and LTC sectors impact mortality. We analyse data on English local authorities in 2014–15 and employ a sequence of cross‐sectional econometric specifications based on instrumental variables to identify the effect that LTC expenditure has on mortality through its interactions with HC services, and vice versa. Our findings suggest that any effect of LTC expenditure on mortality is likely to run through the HC sector by allowing the latter to reallocate resources from less to more effective services. A 10 per cent increase in LTC expenditure per user can indirectly save, on average, about three lives per million individuals. In addition, on top of the known HC direct mortality effects, we find that investing an extra £42 million in the HC sector – equivalent to a 10 per cent increase in HC expenditure per capita for the average local authority – can decrease the use of LTC services, producing around £7.8 million of savings. These can generate mortality effects if invested in services having an impact on mortality.

Association of Depressive Mood and Frailty With Mortality and Health Care Utilization: Korean National Cohort Study.

To investigate the association of depressive mood and frailty with mortality and health care utilization (HCU) and identify the coexisting effect of depressive mood and frailty in older adults. A retrospective study using nationwide longitudinal cohort data. A total of 27,818 older adults age 66 years from the National Screening Program for Transitional Ages between 2007 and 2008, part of the National Health Insurance Service-Senior cohort. Depressive mood and frailty were measured by the Geriatric Depression Scale and Timed Up and Go test, respectively. Outcomes were mortality and HCU, including long-term care services (LTCS), hospital admissions, and total length of stay (LOS) from the index date to December 31, 2015. Cox proportional hazards regression and zero-inflated negative binomial regression were performed to identify differences in outcomes by depressive mood and frailty. Participants with depressive mood and frailty represented 50.9% and 2.4%, respectively. The prevalence of mortality and LTCS use in the overall participants was 7.1% and 3.0%, respectively. More than 3 hospital admissions (36.7%) and total LOS above 15days (53.2%) were the most common. Depressive mood was associated with LTCS use [hazard ratio (HR) 1.22, 95% confidence interval (CI) 1.05-1.42] and hospital admissions [incidence rate ratio (IRR) 1.05, 95% CI 1.02-1.08]. Frailty had associations with mortality risk (HR 1.96, 95% CI 1.44-2.68), LTCS use (HR 4.86, 95% CI 3.45-6.84), and LOS (IRR 1.30, 95% CI 1.06-1.60). The coexistence of depressive mood and frailty was associated with increased LOS (IRR 1.55, 95% CI 1.16-2.07). Our findings highlight the need to focus on depressive mood and frailty to reduce mortality and HCU. Identifying combined problems in older adults may contribute to healthy aging by reducing adverse health outcomes and the burden of health care costs.

Impact of COVID-19 on Long-Term Care Service Utilization of Older Home-Dwelling Adults in Japan.

The COVID-19 outbreak severely affected long-term care (LTC) service provision. This study aimed to quantitatively evaluate its impact on the utilization of LTC services by older home-dwelling adults and identify its associated factors. A retrospective repeated cross-sectional study. Data from a nationwide LTC Insurance Comprehensive Database comprising monthly claims from January 2019 to September2020. Interrupted time series analyses and segmented negative binomial regression were employed to examine changes in use for each of the 15 LTC services. Results of the analyses were synthesized using random effects meta-analysis in 3 service types (home visit, commuting, and short-stay services). LTC service use declined in April 2020 when the state of emergency (SOE) was declared, followed by a gradual recovery in June after the SOE was lifted. There was a significant association between decline in LTC service use and SOE, whereas the association between LTC service use and the status of the infection spread was limited. Service type was associated with changes in service utilization, with a more precipitous decline in commuting and short-stay services than in home visiting services during the SOE. Service use by those with dementia was higher than that by those without dementia, particularly in commuting and short-stay services, partially canceling out the decline in service use that occurred during the SOE. There was a significant decline in LTC service utilization during the SOE. The decline varied depending on service types and the dementia severity of service users. These findings would help LTC professionals identify vulnerable groups and guide future plans geared toward effective infection prevention while alleviating unfavorable impacts by infection prevention measures. Future studies are required to examine the effects of the LTC service decline on older adults.

Association between use of different long-term care services and risks of mental disorder and mortality as well as medical utilization.

This study sought to investigate mental disorder and mortality risks and medical utilization among various long-term care (LTC) services and examine the associated factors. This retrospective cohort study used data from the National Health Insurance Research Database of the entire population of Taiwan recorded between 2006 and 2017. A total of 41,407 patients using LTC (study group) were identified and propensity score-matched with 41,407 LTC nonusers (control group) at a ratio of 1:1 according to sex, age, salary-based premium, comorbidity index score, and urbanization level. Patients were divided into four groups according to LTC service type. The age distribution was as follows: 50-60 years (10.47%), 61-70 years (14.48%), 71-80 years (35.59%), and 81 years and older (39.45%). The mean age was 70.18 years and 53.57% of female participants were included. The major statistical methods were the Cox proportional hazards model and the general linear model (GLM). Users of both institutional and inhome LTC services had the highest risk of mental disorder [adjusted hazard ratio (aHR) = 3.2]. The mean mortality rate in LTC nonusers was 46.2%, whereas that in LTC users was 90.4%, with the highest found among the users of both institutional and inhome LTC (90.6%). The institutional LTC users had the shortest survival time (4.1 years). According to the adjusted Cox model analysis, the odds of mortality was significantly higher among institutional LTC users than among inhome LTC users (aHR = 1.02). After the adjustment of covariates, adjusted GLM model results revealed that the annual medical expenditure per capita of LTC nonusers was NT$46,551, which was 1.6 times higher that of LTC users. Users of both institutional and inhome LTC services have higher risk of mental disorder, shorter survival time, and lower medical utilization.

Technological Inequality and Social Exclusion of Older People during the COVID-19 Pandemic

Abstract The digital transformation of contemporary societies may already have been seen by older people as an obstacle; during the pandemic, however, great emphasis was given to technology. The purpose of this article is to illustrate the phenomenon of social exclusion of older people, linked to their vulnerability and the “COVID circumstances” and shaped by the various measures imposed by different countries to limit physical contact, which led to technological inequality. The findings emphasize the isolation of the elderly and their non-use or insufficient use of health services and long-term care services. Further implications relate to socioeconomic costs arising from the inefficient treatment of their needs regarding their physical and “technological” vulnerability. The article concludes with considerations of the importance of distinct—both individually and collectively oriented—approaches to create better social conditions that will enhance technological equality for the elderly.

Determinants associated with medical-related long-term care service use among community-dwelling older adults in Taiwan

IntroductionMedical-related long-term care (LTC) service use among community-dwelling older adults in Taiwan is resource-intensive, and planning is essential to promote aging-in-place. MethodsAdministrative data from 4/1/2017 to 11/26/2019 among more than 14,000 residents were analyzed with generalized estimating equations (GEEs) to identify determinants of medical-related LTC service use. ResultsOlder adults using medical-related LTC services tended to be younger (79.9 vs. 80.7; p<.0001), male (42.7% vs. 38.5%; p<.0001), multi-morbid (3.1 vs. 2.5; p<.0001), and higher mean activities of daily living (ADL) disability (8.2 vs. 4.2; p<.0001), instrumental ADL (IADL) disability (11.0 vs. 9.1; p<.0001), and hospitalizations (1.1 vs. 0.4; p<.0001). Significant determinants of medical-related LTC services include age, education, stroke, coronary heart disease, diabetes, vision impairment, ADL disability, and prior hospitalization. DiscussionThe success of LTC 2.0 will depend on ADL support and care coordination to manage chronic conditions such as diabetes, vision impairment, coronary heart disease, and stroke.

Community-Dwelling Older Adults' Intended Use of Different Types of Long-Term Care in China and Its Associated Factors Based on the Andersen Behavioral Model.

In light of the increased demand for long-term care services in China, there is an ongoing discussion on what factors contribute to older adults’ intended use of long-term care services. This study empirically recruited 239 community-dwelling older adults aged ≥60 years in China and explored factors influencing their intended use of four types of long-term care (basic life care, basic medical care, rehabilitation care, and psychological care) based on the Andersen behavioral model (i.e., predisposing characteristics, enabling resources, and need factors). The results showed that older adults were most likely to use psychological care. Age (as the predisposing characteristic) was the significant predictor of the intended use of four types of care. Regarding the intended use of basic life care, the enabling resources of marital status, household composition, income, as well as need factors of preference for the care setting, were influential. Moreover, income and need factors of self-rated physical health status were only two variables associated with the intended use of basic medical care. Concerning the intended use of rehabilitation care, household composition, income, self-rated physical health status, and preference for the care setting were significant predictors. The intended use of psychological care was influenced by enabling resources of marital status, household composition, and need factors of self-rated physical health status, preference for the care setting, and preference for the caregiver. These results can promote the sensitivity of policymakers and caregivers to the community-dwelling older adults’ intended use of long-term care and contribute to the delivery of appropriate care services by public policy.

Change in long-term care service usage in Japan following the COVID-19 pandemic: A survey using a nationwide statistical summary in 2018-2021.

AimSocial restrictions due to the coronavirus disease (COVID‐19) pandemic forced many long‐term care (LTC) service‐users to refrain from using services. We aimed to evaluate the degree of change in the use of LTC services.MethodsWe retrospectively analyzed data from the publicly distributed nationwide statistics summarizing the monthly number of public LTC insurance users in Japan between April 2018 and March 2021. The degree of decline was quantified as a ratio, where the ratio of a certain month to the reference month was divided by the ratio in the previous year.ResultsThe use of LTC services started to decline in March 2020 and reached its largest decline in May 2020. Thereafter, it recovered but insufficiently, even as of late 2020. The degree of decline was particularly large for services provided in facilities for community‐dwelling elderly individuals [Ratio to the previous year = 0.717 (95% CI: 0.645–0.796) in short‐stay services, and Ratio = 0.876 (95% CI: 0.802–0.957) in outpatient services], but was non‐significant in other types of services, including those provided for elderly individuals living in nursing homes.ConclusionsCommunity‐dwelling elderly individuals who had used outpatient or short‐stay services were especially affected by the COVID‐19 pandemic in 2020. This underlines the need for further investigation of the medium‐ or long‐term influence of the decline in service usage on the mental and physical health of the LTC service‐users and their caregivers. Geriatr Gerontol Int 2022; 22: 803–809.

Explaining Variations in Long-term Care Use and Expenditures Under the Public Long-term Care Insurance Systems: A Case Study Comparison of Korea and Japan.

Establishing universal coverage of formal long-term care (LTC) services is an urgent policy need for aging populations that requires efficient management of quality and financing. Although current variation in LTC service use between and within countries suggests the potential for improvement by efficient management, this topic remains underexamined. We aimed to identify the sources of variance in LTC use and expenditures through a unique cross-country comparison of Japan and South Korea, which have formal public LTC insurance (LTCI) schemes that are analogous but have unique operational and demographic structures. Taking administrative regions as the unit of analysis, we assembled data on the LTC utilization rate of people aged ≥65 years, and expenditures per recipient from 2013 to 2015 as the outcome variables. Explanatory variables included demand-related factors, such as regional demographic and economic conditions, and supply characteristics derived from existing public databases. We conducted weighted least squares regression with fixed effects for the pooled data and used Blinder-Oaxaca decomposition to identify sources of outcome variance between the two countries. The average LTC utilization rate was 6.8% in Korea and 18.2% in Japan. Expenditures per recipient were approximately 1.4 times higher in Japan than in Korea. The difference in the utilization rate was mostly explained by between-country differences in supply- and demand-related factors, whereas the difference in expenditures per recipient was largely attributed to unobserved country-specific factors. The current findings suggest that LTC utilization is determined largely by the demographic and functional characteristics of older people, whereas expenditures are more likely affected by institutional factors such as the insurance governance scheme and the policy choice of the target population segment and coverage. The results suggest that strategic choice of LTC institutional schemes is required to ensure financial sustainability to meet changing demands caused by population aging.

The Impact of Multiple Long-Term Care Services Use on Dementia and Nondementia Caregivers' Health Care Utilization and Costs.

The study examined the effects of multiple long-term care (LTC) services (i.e., using both social and professional care services) on caregivers of service recipients with and without dementia. We retrieved data for 10,771 caregivers of older adults in the Ten-Year Long-Term Care Project (TLTCP) in Taiwan. We examined the effects of care recipients' initial prescription of single or multiple LTC services on their caregivers' healthcare services use, including outpatient, emergency department (ED), and inpatient services. For care recipients prescribed a single LTC service, dementia caregivers had 0.82 more ED visits and 10.4% higher total fees than nondementia caregivers (p < .05). However, for care recipients prescribed multiple LTC services, dementia caregivers and nondementia caregivers used healthcare services at similar levels, and dementia caregivers had 3.5% lower per-visit outpatient fees (p < .05). Providing multiple LTC services for people with dementia results in great benefit to their caregivers.

Association between timed up and go test and future incidence of disability: A nationwide representative longitudinal study in Korea

Although previous studies examined the association between mobility and disability, they have used either subjective measure disability such as activity of daily living or instrumental activity of daily living or indirect measure such as long-term care service use with small size of participants. This study aimed to examine the association between timed up and go (TUG) test and disability incidence with national disability registration data in Korea longitudinally, by using a national representative sample. We used the National Health Insurance Service–National Health Screening Cohort (NHIS–HEALS) database of National Health Information Database. The NHIS–HEALS dataset includes disability information of National Screening Programme participants, including registration date and type of disability, which is merged from Korean National Disability Registry (KNDR). We used Cox proportional hazard models to evaluate the association between TUG and disability incidence. We constructed three models with different levels of adjustment; Model 3 was a fully adjusted model. We conducted subgroup analysis according to the risk factors for disability. The study population comprised 81,473 participants; 86 of them were newly registered to KNDR, which were observed during a mean follow-up of 4.1 ± 2.6 (maximum, 8.9) years. For 334,200.9 person-year (PY) follow-up, the disability incidence rate was 0.208 per 1,000 PY. Disability incidence was significantly higher in participants with abnormal TUG results than in those with normal TUG results. (adjusted hazard ratio [aHR] 1.600, 95% confidence interval [CI] 1.036–2.472). In subgroup analysis, the disability incidence increased in participants of normal cognition, without obesity or without cardiovascular (CV) disease. Increased incidence in disability was noted in participants with abnormal TUG results. The increase was more evident for participants with normal cognition, without obesity or CV disease.

장기요양 서비스 이용 패턴 유형 및 특성 연구

The purpose of this study is to categorize long-term care service use patterns and to identify differences and changes in characteristics by type. By applying the sequence analysis method to the Senior DB of the National Health Insurance Service(NHIS), the long-term care service use patterns were categorized. We tracked the transitions between long-term care in-home benefits, long-term care facilities (LTCFs), and long-term care hospitals (LTCHs) experienced by the same individual. Differences and changes in service use patterns type were comprehensively analyzed. As a result of the analysis, long-term care service use patterns were categorized into 11 types. The pattern type of continuing to use the service that has been started occupied the majority. The transition from home to facility(LTCFs/LTCHs) was subdivided into types by the transition period, while the transition from facility to home was not identified as a type. Among the types of transition from home to facility(LTCFs/LTCHs), the proportion of transition to LTCFs and transition to LTCHs was 2:1. While the transition from home to LTCFs accounts for a greater proportion, transitions from home to LTCHs have also been significant. As a result of comparing demographic characteristics, care needs, family care resources, and economic resources by type of long-term care service use pattern, a resource gap was found between the types. Accordingly, policy and practical tasks were proposed for rational use of long-term care services and support for living in the community.&#x0D;

Determinants of long-term care service use by persons with dementia: A national dementia registry study conducted in Taiwan.

This study investigated the determinants and use of Taiwan's long-term care (LTC) Plan Version 2.0 (LTC 2.0) services by persons with dementia (PWDs) and their caregivers. In total, 1268 PWD-caregiver dyads were enrolled for analysis from a national dementia registry. Andersen's Behavioral Model of Health Services Use was used to investigate the association of LTC service use with several factors, namely the demographic data of PWDs and their caregivers, migrant caregiver employment, monthly household income, caregiver burden as determined by the Zarit Burden Interview (ZBI), Mini-Mental State Examination score, Clinical Dementia Rating scores, neuropsychiatric inventory scores for the behavioral and psychological symptoms of dementia, and PWDs' activities of daily living (ADLs). Among the studied family caregivers, 81.4% did not use LTC resources. A multivariable logistic analysis revealed that aberrant motor behaviors (odd ratio [OR]=1.31, 95% confidence interval [CI]=1.10-1.56, p=0.003), dysfunction in ADLs (OR=1.06, 95% CI=1.02-1.10, p=0.002), higher ZBI scores (OR=1.02, 95% CI=1.01-1.03, p=0.004), not residing with family members (OR=1.88, 95% CI=1.32-2.66, p<0.001), and not employing a migrant caregiver (OR=4.41, 95% CI=2.59-7.51, p<0.001) were the factors most significantly associated with LTC service use. Factors such as whether PWDs live alone, specific neuropsychiatric symptoms, and impaired function should be considered in future policy amendments to provide required activities and care resources for PWDs and their caregivers.

Do characteristics of family members influence older persons\u2019 transition to long-term healthcare services?

BackgroundFuture demographic and economic changes warrant a better understanding of older persons’ need for health-related long-term care services (LTC). LTC uptake among older people is likely to be influenced by the presence or absence of family members, but there is scarce research on the role played by partners with different caregiving potential. There is even less research on the contributions of adult children and their caregiving potential. The current study examines the extent to which transitions into LTC in older men and women differ according to the presence and caregiving potential of partners and children.MethodsLinked registry data for Norway on older persons (aged 65+), their partners, and their adult children are used to examine how characteristics of these family members influence transitions into LTC from 2010 to 2016, using logistic discrete-time hazard regression models. We observed around 215,000 transitions to LTC, corresponding to around 26.3% of individuals and 5.4% of the total person-years (4.0 million). Caregiving potential is measured in terms of employment, income, health and educational attainment for partners and education and geographical proximity for children.ResultsPersonal, partner and child(ren)’s resources are all associated with older persons’ LTC uptake. Unpartnered and/or childless older people are more likely to use LTC than those with partners and/or child(ren). Older persons with resourceful partners and children are the least likely to transition into LTC. The geographical proximity of adult children appears to have only a minor influence on LTC use among older people.ConclusionsPopulation ageing and strained public resources will likely challenge the future provision of formal old-age care. The role of family networks in the future provision of formal old-age care is expected to become progressively important in the years to come. Inequalities in the health, care and welfare of older persons with and without resourceful family members are likely to increase.

Policy Issues Affecting the Health of Older Individuals in the United States

The aging population is growing, in the United States and the rest of the world. Developed nations are now facing challenges with providing for this increasing unit of population. Aged adults account for a significant part of individuals utilizing health care services in these countries. As a result of this growth, long-term policies in the healthcare of the elderly need to be reviewed. This manuscript offers insight into the policies and the several elements that affect the provision of healthcare to the aging populace. Some of the issues addressed include medical care needs versus supply, alternatives to institutionalization, alternative delivery systems, financing long-term care services, the role of informal support systems, housing, and income maintenance. The demand for use of long-term care services is also significantly growing. Socioeconomic status and health behaviors throughout life affect the need for these services. However, financing and access to these services have become a concern for governments, and papers like this offer relevant data which can be used to reform and make informed policies.