Long-term Care Services Research Articles

The Effect of Business Operating Systems on Nursing Home Termination.

Objectives: Nursing home terminations have increased worldwide due to rising costs, staffing shortages, and the coronavirus disease pandemic. However, little is known about the impact that business operating systems have on nursing home termination. Methods: This study used the National Long-term Care database, which comprised 7,842 operating nursing homes in January 2018. Nursing home termination was identified when nursing homes discontinued provision of long-term care services to all residents between January 2018 and December 2020. Business operating systems that were reimbursed by the LTC insurance system were the exposure of interest. The logistic regression model for nursing home termination included a series of organizational, internal, and external factors as covariates. Results: From 2018 to 2020, 83 (1.1%) nursing homes were terminated. The proportion of reimbursed nursing homes varied greatly depending on the type of business operating systems. Implementing physical function training and improving working conditions were significantly associated with a lower risk of nursing home termination. Conclusion: Financial incentives to several business operating systems are an effective way to build a sustainable environment for nursing homes to continue to exist.

Does Long-Term Care Literacy Matter in Evaluating Older Care Recipients' Satisfaction with Care Managers? Empirical Evidence from Japanese Survey Data.

In this study, we focused on the long-term care literacy of care recipients (older adults currently receiving formal care services) and examined its relationship with satisfaction with their care managers by using a unique individual dataset of Japanese people aged 65 years and older. To address the problem of non-respondent bias, we applied inverse probability weighting and the Heckman probit model for estimation. We found that the probability of older adults evaluating their satisfaction regarding the six aspects of care manager measurement increased with an increasing level of care literacy. However, concerning the level of satisfaction with their care managers, we only observed significant increases in the aspects of "Explanation power" and "Attitude and manners" as the level of care literacy increased. Covariates, such as age, gender, family structure, level of certification for long-term care, reasons for choosing the care manager, utilization of long-term care services, and the manner in which older respondents answered the survey questions, also mattered regarding the evaluation process of satisfaction of older adults. In Japan, utilizing formal care services based on the long-term care insurance system is complicated and sometimes difficult for older adults to understand. In this survey, 35% of older care recipients had inadequate care literacy. Improving the care literacy of older adults is important for better use of formal care services and increased satisfaction.

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.

Cognitive frailty increases the risk of long-term care dependency in community-dwelling older adults: A nationwide cohort study in South Korea.

To investigate whether cognitive frailty, compared with physical frailty or cognitive impairment alone, substantially increased the risk of long-term care (LTC) initiation in community-dwelling older adults. Subjects comprised a total of 39 148 participants aged 66 years from the Korean National Health Insurance-Senior cohort database. Cognitive frailty was defined as the coexistence of physical frailty and cognitive impairment, which was measured by the Timed Up and Go test and the Korean Dementia Screening Questionnaire-Prescreening, respectively. A stratified Cox model was estimated to explore the association of frailty status with LTC initiation. The baseline prevalence of cognitive frailty was 8.7%. During a mean follow-up of 5.3 years, 646 older adults started receiving LTC services. Compared with the robust group, older adults with cognitive frailty showed the highest risk of LTC initiation (hazard ratio [HR], 2.65; 95% confidence interval [CI], 2.08-3.35), followed by those with cognitive impairment (HR, 1.62; 95% CI, 1.26-2.07) and physical frailty (HR, 1.50; 95% CI, 1.25-1.81). Furthermore, cognitive frailty in depressed older adults (HR, 3.16; 95% CI, 2.31-4.33) showed a higher risk of LTC initiation than in nondepressed older adults (HR, 2.10; 95% CI, 1.46-3.04). Cognitive frailty was a significant predictor of LTC initiation among community-dwelling older adults, particularly if they are depressed. Early detection and timely intervention may help to delay LTC initiation in older adults with concurrent cognitive frailty and depression. Geriatr Gerontol Int 2023; 23: 117-123.

Prevalence and Risk Factors of Neuropsychiatric Symptoms in Institutionalized Patients with Parkinson's Disease in Taiwan: A Nationwide Observational Study.

Neuropsychiatric symptoms (NPSs) are known to be frequent in Parkinson's disease (PD) with great impacts on the quality of life, but reports about the prevalence in institutions are few. Our aim was to investigate the prevalence of and risk factors for NPSs in institutionalized patients with PD in Taiwan. The National Health Research Institute executed a cross-sectional, community-based, observational study on residential long-term care service institutions. The diagnosis of PD was determined by physicians with the estimated Hoehn and Yahr stage of PD according to the EQ-5D-5L questionnaire. A total of 370 patients with PD (80.1 ± 9.94 years old, 55.1% females) were included, and 139 (37.6%) had more than one NPS in the prior 3 months. The top three NPSs were nighttime behavior (65 (17.6%)), depression (53 (14.3%)), and fear/anxiety (49 (13.2%)). There were no differences between those with NPS and those without NPS in terms of age, gender, education, Mini-Mental State Examination, or Hoehn and Yahr stage. However, multivariate logistic regression analysis showed that genitourinary disease (odds ratio (OR) = 3.13; 95% confidence interval (95%CI) = 1.77-5.51) and psychiatric disorders (OR = 5.18; 95%CI = 3.09-8.69) may be associated with increased risk of NPSs. Increased physical restraint was observed in residents with advanced PD. Genitourinary disease and psychiatric disorders appear to increase the risk of NPSs in institutionalized residents with PD.

Effects of Caregiver's Gender or Distance Between Caregiver and Patient's Home on Home Discharge from Hospital in 285 Patients Aged ≥75 Years in Japan.

BACKGROUND Many hospitalized aged patients in Japan, the most super-aged society, are unable to be discharged home. This study was performed to clarify the factors associated with home discharge, not to a long-term care (LTC) facility or another hospital, among inpatients aged ≥75 years. MATERIAL AND METHODS A single-center prospective cohort study was performed for inpatients aged ≥75 years in a rural acute-care hospital in Japan, from November 2017 to October 2019. We divided the patients into 2 groups: those who resided at home or had died at home by 30 days after discharge, and others. We obtained data from medical charts and questionnaires given to patients and their caregivers. For each factor shown to be statistically significant by the univariable analysis, a multivariable analysis with adjustment was conducted. RESULTS In all, 285 patients agreed to participate. With adjustment by where the patient was admitted from, residing with other family members, cognitive function scores, and Barthel index, multivariable analysis using each factor identified as relevant by univariable analysis identified the following as associated with home discharge: being less informed about LTC insurance; cost of home-visit medical, nursing, or LTC services; shorter hospital stays; close proximity between patient and caregiver; main caregiver being female; and life expectancy of over 6 months (P<0.05). CONCLUSIONS Male gender and a long distance between the caregiver and patient's home significantly hindered home discharge in patients aged ≥75 years, suggesting the need to provide information regarding home-visit services under Japan's LTC insurance system for such caregivers.

Comparative Analysis of Long-Term Care in OECD Countries: Focusing on Long-Term Care Financing Type.

This study aims to examine the characteristics of long-term care (LTC) financing in Organization for Economic Cooperation Development (OECD) countries. To this end, the 26 OECD countries that have introduced LTC systems were classified into three types of models: tax-based, health insurance, and LTC insurance (LTCI) systems. Thereafter, these systems were analyzed using Gilbert and Terrell's policy analysis framework. The results indicated differences in the characteristics of each type of financing in terms of allocation, benefit provision, service delivery, and finance. It is likely that while the LTC insurance model was mainly based on universalism and showed the highest level of coverage, the tax-based and health insurance models adopted selectivism with lower level of benefits per capita. In terms of service delivery, local authorities tended to have the responsibility to decide LTC service users and provide services in many countries, regardless of the type of model. In terms of finance, LTC insurance-based countries had the highest LTC expenditure as a percentage of GDP, followed by countries with tax-based and health insurance systems.

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.

Konceptualizacija politika dugotrajne nege (long term care) za stariju populaciju - analiza (ne)usaglašenosti Srbije sa karakteristikama u politikama prisutnim u EU

Long-term care policies are aimed at the most vulnerable parts of the population and are characterized by the (non) existence of opportunities, choices, alternatives, lack of (or not) the autonomy of choice, human rights, and the humanity of society. Thus, through the conception of social policies of long-term care, the social relationship towards those who are long-term dependent on other people's support in order to perform their daily activities, meet basic needs, and be socially integrated is regulated. This work focused on the analysis of the compliance of these aspects of social policy in Serbia and the European Union, using the comparative method, in relation to the indicators of the relevant areas. The subject of the research is focused on social policies and that part of them that refers to the long-term care of the elderly population. Territorial determination implies an analysis of the situation in the Republic of Serbia and the countries of the European Union. The aim of the work was to determine the similarities and differences in the basic elements of long-term care policies, and to conduct a comparative analysis in relation to the Republic of Serbia and relevant representatives of the corresponding sociopolitical models recognized in the member states of the European Union. The paper tried to answer the question of whether there are differences in the formulation and provision of long-term care, as well as what are the similarities and differences in content, both in relation to the determined funds and the available support activities. Through the analysis, it was determined that the comparison of Serbia and EU representatives identifies that the characteristics of long-term care that are present in EU countries and Serbia indicate many differences and some similarities. The similarity is observed in the demographic indicators, as well as in the declarative determination to follow the concept of deinstitutionalization. However, the following of this concept is different in Serbia and EU countries, because the indicators show that in the EU there is a far greater number of users of services that support staying at home with help and support. In Serbia, the situation is different and the number of users of accommodation and support services in a natural environment is very similar. Also, the difference that is present in this context is in relation to the percentage of the population that uses long-term care services. In our country, that percentage is significantly lower than in EU countries. Significant differences are also observed in relation to the position and support of informal caregivers. In the Republic of Serbia, this type of support is not even normatively recognized, and institutional mechanisms do not provide any assistance to these persons. Unlike Serbia, the EU has defined various support mechanisms for this category of population.

Quality of Services Provided by Social Care Centres for the Elderly in Latvia: Challenges and Possible Solutions

Latvia faces the challenges of an ageing society, which increases the demand for long-term social care services at municipal level. The aim of the work was to address the problematic issue related to the quality assurance and control of the care service for people of retirement age and the improvement of this quality control process in SCCs in Latvian municipalities. In addition, an analysis of the administrative data of social care homes in Latvia was carried out. The authors have concluded that currently, the arrival at an objective assessment of SCC service quality is impossible. The content of this work allows to argue that quality indicators (QI) should be integrated within SCC quality assessment, thus providing several advantages in terms of service planning and quality assessment, and the use of data for high quantity research.

Quality of Municipal Long-Term Care in Different Models of Care: A Cross-Sectional Study From Norway.

The quality of care remains a critical concern for health systems around the globe, especially in an era of unprecedented financial challenges and rising demands. Previous research indicates large variation in several indicators of quality in the long-term care setting, highlighting the need for further investigation into the factors contributing to such disparities. As different ways of delivering long-term care services likely affect quality of care, the objectives of our study is to investigate (1) variation in structure, process and outcome quality between municipalities, and (2) to what extent variation in quality is associated with municipal models of care and structural characteristics. The study had a cross-sectional approach and we utilized data on the municipal level from 3 sources: (1) a survey for models of care (2) Statistics Norway for municipal structural characteristics and (3) the National Health Care Quality Indicator System. Descriptive statistics showed that the Norwegian long-term care sector performs better (measured as percentage or probability) on structure (85.53) and outcome (84.86) quality than process (37.85) quality. Hierarchical linear regressions indicated that municipal structural characteristics and model of care had very limited effect on the quality of long-term care. A deeper understanding of variation in service quality may be found at the micro level in healthcare workers' day-to-day practice.

Analysis of the Current Status of Long-Term Care Services for Elderly Patients with Hip Fractures

Analysis of the Current Status of Long-Term Care Services for Elderly Patients with Hip Fractures

NGOS and stakeholder cooperation in long term care organizing and delivery: an equal player or an outlier?

This paper summarizes the arguments and counterarguments within the scientific discussion on the issue of inter-sectoral and inter-organizational cooperation in long-term care service policy-making, organizing and delivery with a specific focus on NGO role in it. The main purpose of the research is to explore the current situation, with a specific focus on NGO role in it, and look into some drivers of stakeholder cooperation in LTC organising and delivery and to compare them across public and private LTC providers and NGOs. Systematization of the literary sources and approaches indicates that NGOs’ role in stakeholder cooperation is unique due to the nature of their non-profit philosophy. The relevance of this scientific problem decision is that inter-organisational LTC cooperation with and by tertiary sector organisations has to date received very modest research attention, and is inconclusive and fragmented. This leads to not meeting growing needs for LTC services and increasing public costs. Investigation of the topic first offers empirical evidence on stakeholder cooperation in LTC policy development, organising and delivery across multiple stakeholder groups in three sectors – public, private and NGOs. In addition, it pays specific attention to NGOs role and engagement in LTC and identifies stronger and weaker areas of cooperation with other stakeholders. The paper also identifies several cooperation drivers and measures them in LTC field. The study builds on the findings of a survey of key LTC stakeholders in Lithuania (n=215). Results show that current NGO engagement in cooperation is lower in comparison to public and private LTC service providers and their cooperation is mainly limited to the sphere of LTC service delivery at an individual level, and family members, social workers and other NGOs make key stakeholder groups they cooperate with. The research empirically confirms that NGOs are outliers in cooperation in long-term care policy development, organising and delivery across multiple stakeholder groups. The results of the research can be useful for all the stakeholders in LTC policy field and service provision.

A New Portable Home Nursing Care Support System with Scheduling and Flexible Real-time Routing Mechanism

&lt;p&gt;With the rapid growth of the elderly population, the need for long-term medical care continues to increase, and reliance on medical and institutional nursing care services is limited. Long-term nursing care at home is a kind of home care service which provides continuous nursing care after discharge from the hospital and is an alternative long term care choice that can relieve the hospital from the pressure of too many long-term care beds. Therefore, how to integrate limited medical resources and create a mobile home care model that attracts more manpower willing to devote themselves to the long-term care service and can upgrade the value of nursing information system has always need a breakthrough in the medical information field. This research is built upon the mobile computing technology to construct a new portable home nursing care support system. The result shows that this mobile home nursing care support mechanism can help patients and their families maintain good quality of life and dignified living. At the same time, caregivers are provided with intelligent guide and medical information support during their implementation of home care medical measures, thereby excluding redundant non-professional medical details and improve the quality of home health care service.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Impact of the Industrialization of Older Adult Care Services on Older Individuals' Physical and Mental Health: Evidence from China's Quasi-Natural Experiment.

Given the increasing longevity of the population, the consolidation of familial structures, and the scarcity of economic resources required to sustain an aging society, the Chinese government faces a complex and urgent challenge in effectively addressing the growing needs of older adults and establishing a long-term care services system that is both sustainable and equitable. This study harnesses the comprehensive CLHLS data from 2011 to 2018 and utilizes the "Pilot Industrialization of Old-Age Service in a Market-Oriented Way" policy as a quasi-natural experiment. Employing the Difference-in-Differences (DID) method, our study aims to evaluate the impact of industrializing older adult care services on the physical and mental health outcomes of older adults in China. The findings strongly indicate that the government's adoption of a market-driven fiscal approach within its policies, aimed at attracting social capital and fostering the industrialization of older adult care services, positively influences the physical and mental well-being of the aged population. Furthermore, through heterogeneity analysis, it becomes evident that the health promotion effect is particularly pronounced among older individuals living without a spouse, lacking family care from children or grandchildren, or residing in financially underdeveloped regions. In summary, these results underscore the potential efficacy of employing financial policy instruments to facilitate the industrialization of older adult care services, thereby advancing the promotion of a society characterized by healthy aging and ensuring equitable health outcomes for older people.

失能老人长期照护服务的法律困境与对策研究

失能老人长期照护服务的法律困境与对策研究

Care-needs level prediction for elderly long-term care using insurance claims data

Background and objectiveOwing to an aging population, the increase in the number of elderly people certified as requiring long-term care has become a critical social issue in Japan. This study aimed to construct a machine learning model predicting the maximum care-needs level required for long-term care within the next three years for persons aged over 75 years. MethodsThe prediction model was constructed using features extracted from long-term care and healthcare insurance claims data. The study subjects were a total of 47,862 elderly individuals who had not received long-term care services in a large city in Japan. The prediction classes for outcome variable were categorized according to the criteria of the Japanese long-term care system: class 0 (no required), class 1 (support levels 1 and 2), class 2 (care levels 1 and 2), and class 3 (care levels 3–5). As explanatory variables, a total of 516 features were used, including age, sex, and 514 diseases classified under ICD-10. In this study, we focused on constructing a prediction model with the interpretability and adopted multinomial logistic regression (MLR) with L2 regularization as a machine learning algorithm. MLR allowed us to identify the characteristics influencing each prediction class of care-needs levels. ResultsIn terms of overall predictive performance, MLR achieved weighted average precision, recall, F-value, and lift scores of 0.694, 0.505, 0.567, and 1.333, respectively. Compared to other machine learning algorithms, MLR demonstrated comparable performance to Support Vector Machine (SVM) and Random Forest (RF). From the factor analysis based on the magnitudes of coefficients of the MLR model, the top three features influencing each prediction class were as follows: class1: female sex, hypertension, and gonarthrosis; class 2: age, Alzheimer-type dementia, and neuromuscular dysfunction of the bladder; class 3: age, Alzheimer-type dementia, and type 2 diabetes mellitus. ConclusionsIn practical terms, the care-needs level prediction can be applied by local governments to identify high-risk areas by comprehensively and routinely predicting insured persons under public health insurance and long-term care insurance systems.

Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables.

Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.

Utilization of Public Long-Term Care Services and Burden Alleviation of Service Recipients and Their Families: Home Care and Institutional Care for Older Adults in South Korea

South Korea launched national long-term care insurance in 2008, and about one in ten older adults currently receives public long-term care (LTC) services. However, little research using nationally representative data has examined the factors related to LTC services and burden alleviation. Using Andersen’s health service utilization model, this study aims to explore the factors associated with the utilization of LTC services (i.e., home care services and institutional care services) in South Korea. Further, the alleviation of the burden (i.e., emotional, financial, and physical) among the service recipients and their family members are studied. We performed logistic regressions using national data: the 2019 Long-Term Care Survey (N=3,601). The results showed that living in urban areas and having fewer mobility limitations were associated with higher emotional and physical burden alleviation of home care service users. Moreover, living in urban and having longer geographic distances from the families were associated with more elevated financial burden alleviation. In terms of institutional care services, when the service recipient had fewer children, more chronic diseases, and lived in urban areas, the financial burden alleviation was higher. Based on the findings, we discussed the policy implications of the factors related to service utilization which varied by service and burden types.

Influencing factors of willingness to purchase long-term care insurance for employees in Shenzhen, China

Purpose: In the early stage of Shenzhen's long-term care insurance pilot, the awareness, demand, and purchase intention of Shenzhen residents about long-term care insurance and their influencing factors were investigated to provide a basis for improving the government's long-term care insurance system. Methods: A structured questionnaire survey was carried out on the Shenzhen employee medical insurance participants. Descriptive statistics, Chi-square test, and Order logistic regression were performed. Results: 298 respondents (female 57.7%), filled out the questionnaires. About 73% of the respondents have never heard of long-term care insurance. Respondents’ average demand of long-term care was 3.06, which was the general level. The 161(54%) respondents' willing to purchase long-term care insurance and the main influencing factors of purchase willingness are self-assessment of long-term care possibility, monthly income, annual family income and their willingness to pay for long-term care services. Conclusions: Respondents lack risk awareness and have low awareness of long-term care insurance; their effective demand for long-term care insurance is insufficient, but the demand for long-term care services is specialized and diversified, and their intention to purchase long-term care services is slightly higher than purchase intention of long-term care insurance. Recommendations: Departments at all levels should work together to strengthen the publicity of long-term care insurance to raise awareness among the population, improve the quality of practitioners, and improve the elderly care service system to meet the needs of the specialized and diverse population, and broaden financing channels to deal with the risk that the population is not willing to buy.