LTC Services Research Articles

Analyzing the demographic coherence of selected US, Australian and Chinese biometric data sets used to price long-term care insurance and life care annuities

This paper examines the implicit healthy life expectancy used for actuarial calculations in some selected biometric data sets from the US, Australia and China. We are interested in checking the demographic/epidemiological coherence of these data sets because this health indicator is rarely presented when authors build their biometric data sets, nor when they are used to calculate long-term care insurance (LTCI) and life care annuity (LCAs) premiums, nor when they are employed in research articles to estimate the future demand for LTC services. We follow a methodology based on multistate life table methods that enables us to obtain a life expectancy matrix for individuals on the basis of their initial health state. We also present some additional indicators of longevity, mortality and morbidity, these being the median age at death, the interquartile range, the weighted modal age at death, the mortality ratio and the implicit LTC prevalence rates broken down by health state. We find several weaknesses that highlight the difficulty involved in building the biometric data sets needed to make an actuarially fair valuation of the premiums for LTCI and LCAs. We also verify the existence of the so-called “male–female health-survival paradox”. From the perspective of a potential purchaser of this type of insurance products, disclosing and explaining the summary measures of health and longevity would make it easier for them to understand the need to protect themselves against the cost of possible LTC services and also make the computation of the premiums more transparent.

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.

IMPROVING SERVICES TO LGBTQ+ OLDER ADULTS: NEEDS OF MICHIGAN LONG-TERM CARE PROVIDERS

Abstract Long term care (LTC) providers need information about providing competent care to LGBTQ+ older adults. Providers who are not educated can inadvertently provide biased care. Our research identified preferences for education among providers of LTC services in Michigan (MI). In this descriptive cross sectional study we used an online survey to collect data from MI facilities (N= 429). Survey items included facility characteristics, diversity training history, perceived need for training on LGBTQ+ older adults, barriers to training, interest in additional training on LGBTQ+ older adults and LTC, and training preferences. Results were obtained from 71 facilities. Thirty-seven percent of responses came from direct care workers, 63% from administrators. There was good support for diversity training, with 24% stating diversity training was “somewhat important” and 74% stating it was “very important”. A majority (63%) had had some diversity training in the past year. Most (72%) endorsed the need and desire for more training on LGBTQ+ aging. More content on transgender older adults and concerns such as room assignments, dementia, and use of pronouns were identified. Barriers to training included: cost, availability of trainers with the appropriate expertise, ability to reach large numbers of employees, staff turnover, bias and ignorance among staff and residents, and need to provide rationale for this type of training. Most endorsed a mixed type of training and a training length between 1 and 3 hours. Diversity training is critical to LTC and needs to be expanded to include needs of the aging LGBTQ+ community.

Trends in the Use of Home LTC Services in Large, Medium and Small Municipalities in Italy: Lessons for the Post-COVID-19 Reappraisal.

Italian Long-Term Care is considered largely inadequate, and the recent COVID-19 pandemic has dramatically exposed its limitations. Public Home Care Services in particular were revealed as under-financed and unable to cover the potential demand for care from the older population. But does the type of municipality and its geographic location play a role in creating or mitigating unmet demand? This is the first study addressing this research question in Italy. Our hypothesis is that older people’s care preferences and care possibilities may vary between small, medium and metropolitan areas, as will the organisation, funding and availability of services, and the combination will influence (unmet) demand for public home care services. In this paper, using nationally representative survey data collected by the Italian National Statistical Institute in 2003 and 2016, we investigate changes and differences in the use of public and private home care services among people aged 75 or older in Italy by size of the municipality. Our results reveal inequalities in service use between Northern and Southern areas of the country and in particular between metropolitan areas, medium and small municipalities. Such differences reinforce post-pandemic calls for new investment and changes in the design of the Italian Long-Term Care system.

Effectiveness of home- and community-based services in decreasing health care service and expenditure in Taiwan

Background Whether long-term care service use decreases older adults’ health care service use and cost has been a strong interest among aging countries, including Taiwan. The current study examined the impact of continuous use of HCBS offered by Taiwan’s LTC plan 2.0 on older adults’ health service utilization and cost overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 151,548 clients who had applied for and were evaluated for LTC services for the first time from 2017 through 2019 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were users’ health service utilization and health care cost 12 months before and after starting to continuously use HCBS. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 107324, 70.8%), professional care services (n = 30466, 20.1%), and community care services (n = 13794, 9.1%) were identified. When compared to care recipients in the community care group, those in the home-based PC group had more emergency room expenditures (1 point/month, p< 0.05) but less hospitalization expenditures (38 points/month, p<0.001), while the professional care group had less emergency room and hospitalization expenditures (3 and 138 points/month, p< 0.001). Conclusion Those receiving professional care and home care services spent less on health care service utilization.

The impact of HCBS use patterns on older aduts’ physical function among continuous service users

Background Taiwan, one of the fastest aging countries in the world, provides home-and community-based services (HCBS) care recipients through the second 10-Year Long-Term Care Plans (LTC Plans 2.0). The current study aimed to examine the impact of continuous use of HCBS offered by LTC plan 2.0 on older adults’ physical function change overtime. Methods This study used the LTC Plan 2.0 database and the National Health Insurance Plan claim dataset, and included 157,682 clients who had applied for and were evaluated for LTC services for the first time from 2018 through 2020 and continuously used any LTC Plan 2.0 services for six months. Outcome variables were measured by activities ofdaily living (ADLs) and instrumental activities of daily living (IADLs) between baseline assessment and the assessment after the six months of serivce utilization. Latent class analysis and generalized estimating equations were used to investigate the influences of different service use patterns on the changes in physical functions. Results Three subgroups of LTC recipients with different use patterns, including home-based personal care (home-based PC) services (n = 111,976; 71.01%), professional care services (n = 31,584; 20.03%), and community care services (n = 14,122; 8.96%) were identified. When compared to care recipients in the community care group, those in the home-based PC group improved more in IADL scores, and the professional care group improved more ADL scores. Conclusion Those receiving more professional services made more progress in ADL ability, but those in home-based PC made more progress in IADL ability.

Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Self-Efficacy Mediates Acculturation and Respite Care Knowledge of Immigrant Caregivers.

Past studies have shown that acculturation and self-efficacy can affect respite care knowledge, which are notable issues among immigrant caregivers due to the rapid increasing aging family members. The aim of this study was to investigate relationships among acculturation, self-efficacy, and respite care knowledge in immigrant caregivers, and to determine the mediating effects of self-efficacy on the relationship between acculturation and respite care knowledge. A cross-sectional design was used. We enrolled 134 female immigrant caregivers who had married Taiwanese men and lived with care recipients who used LTC services. Based on Baron and Kenny’ mediating analytic framework, multiple regression and Sobel tests were used to examine whether self-efficacy mediated the relationship between acculturation and respite care knowledge. The findings showed that after controlling for confounding factors, acculturation and self-efficacy separately affected respite care knowledge (B = 0.229, standard error (SE) = 0.084; B = 0.123, SE = 0.049, respectively). Acculturation had a positive impact on respite care knowledge through self-efficacy (B = 0.181, SE = 0.084). Therefore, self-efficacy partially mediated the effect of acculturation on respite care knowledge, and accounted for 20.9% of the total mediating effect in this study. Acculturation predicted immigrant caregiver’ respite care knowledge partially through self-efficacy. The association between acculturation and respite care knowledge was partially mediated by immigrant caregivers’ self-efficacy. As a result, it was proposed that boosting self-efficacy could increase and drive immigrant caregivers’ respite care knowledge. To assist this population in obtaining enough resources, targeted educational programs to promote immigrant caregivers’ self-efficacy should be designed and implemented. Furthermore, health care practitioners should be aware of the relevance of immigrant caregivers’ acculturation.

Differences in Function and Healthcare Cost of Older Adults with Dementia by Long-Term Care Service Type: A National Dataset Analysis.

This study aims to analyze the function and cost changes among long-term care insurance (LTCI) beneficiaries with low-severity dementia according to their LTCI service type. Data were collected from the Korean LTCI and national health insurance (NHI) datasets. Participants were 4414 beneficiaries with dementia aged 65 or older who received LTC services continuously for 4 years (2008–2011). LTCI service types were classified into home care (HC), institutional care (IC), and combined care (CC). Activities of daily living (ADL), cognitive function, medical cost, and benefit-cost were assessed. Linear mixed models and multiple regression models were used to analyze the changes in function and costs of the beneficiaries. ADL, cognitive function, medical cost, and benefit-cost differed significantly depending on the service type and time (p < 0.001). LTCI service types affected the degree of changes in ADL, cognitive function, medical cost, and benefit-cost over four years and showed negative changes in IC and CC beneficiaries than HC beneficiaries. HC is a cost-effective way to maintain the function of beneficiaries with low-severity dementia. Thus, efforts are needed to actively promote HC services.

What\u2019s important when caring for a loved one? Population-based preference weights for the Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) for Austria

PurposeThe Adult Social Care Outcomes Toolkit for informal carers (ASCOT-Carer) can be used to assess long-term care-related quality of life (LTC-QoL) of adult informal carers of persons using LTC services. The ASCOT-Carer instrument has been translated into several languages, but preference weights reflecting the relative importance of different outcome states are only available for England so far. In this paper, we estimated preference weights for the German version of the ASCOT-Carer for Austria and investigated the value people place on different QoL-outcome states.MethodsWe used data from a best–worst scaling (BWS) experiment and estimated a scale-adjusted multinomial logit (S-MNL) model to elicit preference weights for the ASCOT-Carer domain-levels. Data were collected using an online survey of the Austrian general population (n = 1001).ResultsTop levels in the domains of ‘Space and time to be yourself’, ‘Occupation’ and ‘Control over daily life’ were perceived as providing the highest utility, and states with high needs in the same domains seen as particularly undesirable. ‘Personal safety’ was the only domain where levels were roughly equidistant. In all other domains, the difference between the top two levels (‘ideal state’ and ‘no needs’) was very small.ConclusionThe paper provides preference weights for the German version of ASCOT-Carer to be used in Austrian populations. Furthermore, the results give insight into which LTC-QoL-outcomes are seen as particularly (un)desirable, and may therefore help to better tailor services directed at informal carers and the persons they care for.

A Qualitative Study on the Experience of Elderly Men Caring Their Wives in Japan

본 연구는 일본의 남성노인 돌봄 경험을 통해 최근 증가하고 있는 한국에서 아내를 돌보는 남성노인에 대한 시사점을 얻는 것을 목적으로 한다. 이를 위해 돌봄 기간이 1년 이상이면서 공식적 돌봄을 이용하고 있는 일본 남성노인 5명을 심층 인터뷰 하였다. 자료 분석은 일반적 질적 연구 분석 방법에 근거하였다. 분석 결과, 5개의 범주가 도출 되었다. 범주는 <돌봄 마주하기와 책임성>, <부담되는 현실과의 직면>, <돌봄 경험의 익숙해짐>, <돌봄 속박의 굴레>, <돌봄의 관계적 경험>이다. 이를 통해 ‘부부관계, 남편으로서의 도리’ 등과 같은 사회적 가치가 돌봄 책임을 수용하는 요인이었으며, 다양한 공적 서비스들이 남성노인의 돌봄 유지에 깊이 관여하고 있는 것으로 파악되었다. 특히 개호보험 제도의 케어매니저 서비스는 남성노인들의 돌봄 전반에 영향을 미치고 있었으며, 다양한 가족지원 서비스 이용은 남성노인들의 돌봄과 일생생활에 부담 감소와 자유를 주는 것으로 나타났다. 따라서 부부간 개입의 중요성, 공식적 돌봄을 통한 돌봄 윤리의 실천 가능성, 고립의 위험성을 시사해 주었다. 분석 결과를 토대로 기존 여성 중심으로 이루어진 노인 돌봄지원 정책에 대한 조정, 한국형 케어매니지먼트 도입, 다양한 서비스의 지원이 한국사회에 필요함을 제언하였다. 마지막으로 장기요양서비스 이용자 외의 돌봄 경험을 살펴보지 못했다는 점과 대도시에 거주하는 남성노인의 경험만을 제한적으로 살펴보았다는 점이 본 연구의 한계라 하겠다.The purpose of this study is to grasp the implications for male elderly care in Korea, which has recently been on the rise through Japan s experience in male elderly care. Five elderly Japanese men providing cares for their wives for more than a year with formal care were interviewed in depth. The data analysis was based on a general qualitative research analysis method. The results were derived from the following five categories: facing care and responsibility, facing the burden of reality, the familiarity with care experience, the ties with burdens of care, and the relationship-oriented experience of care. Social values such as ‘marriage relationship’ and ‘husbandry’ were the main factors that accepted care responsibilities. Various formal LTC services were found to be deeply involved in sustaining care for male elderly people. In particular, the care management service was affecting the overall care and everyday life of the elderly, and the use of various services was found to give freedom to the care life of the elderly. These findings imply the importance of an intervention to one marital unit as a client system, the practicability of care ethics through formal care, and the special needs of isolation of men elderly. Based on these results the study suggests that the Korean society needs to adjust the existing women-centered care policy, to introduce Korean-style care management, and to support various other services for male elderly care givers.

MEDICAID MANAGED LONG-TERM CARE PROGRAMS VS. THE TRADITIONAL MODEL: COMPARATIVE COSTS AND OUTCOMES

Several states have adopted Medicaid Managed Long-Term Care (MLTC) programs over the last several years. At this point at least 30 states are either administering such models or have plans to in the near future. We do not, however, know much yet about the relative cost-effectiveness of the MLTC model when compared to the traditional non-profit model of Medicaid LTC. Is the for-profit MLTC model actually generating savings in the Medicaid program while improving the quality of care? This symposia is designed to address the question through three presentations on experiences with MLTC programs in the states of Ohio, Texas and Pennsylvania and a fourth presentation offering a national overview and critique of Medicaid MLTC in comparison to the traditional Medicaid LTC program still administered through non-profit Aging Network organizations. The state focused presentations describe the current status and results of MLTC in three states that vary in their specific features, extent of formal accountability for outcomes and the political contexts in which the programs currently function. The presentations also include discussions of the implications of each states experiences for the future of Medicaid LTC policy at the state and federal levels. The fourth presentation is a critical analysis of the main differences between the traditional non-profit model of Medicaid LTC services and the for-profit MLTC programs in terms of commonly accepted criteria of cost-effective LTC services, such as access, quality of care and per-person costs and differences in the roles of advocacy and accountability.

RURAL-URBAN DISPARITIES IN UNMET LONG-TERM CARE NEED AND COMMUNITY CARE SERVICES EXPECTATION AMONG ELDERLY IN CHINA

Objective This study aimed to examine the urban-rural differences of unmet needs and their expected LTC services among community-dwelling old people. Methods The data comes from the Chinese Longitudinal Health Longevity Survey (CLHLS) in 2014. A total of 1587 community residents aged 65+ with disability of activities of daily life (ADL) were included in this study. Binary logistic regression was used to estimate correlates of unmet need in LTC. And chi-square test was used to examine the differences of expected community-based LTC services between urban and rural area. Results Over half (55.07%) of the participants reported their need were unmet. For both rural and urban residents, poorer economic status and reluctant caregivers (ORs>1, P＜0.01) seriously affected the unmet need. Besides, of urban older adults, people who were male and lonely(ORs>1, P＜0.05) reported more unmet need. While of rural old ones, people who were with severe ADL disability and poorer self-rated health(ORs>1, P＜0.01) reported more unmet need. And people with available medication and home visit services(ORs<1, P＜0.01) reported more met need. However, the supplies for community LTC care services were far below the demands. Conclusion The risk of having unmet need associated with ADL disabilities in LTC is largely determined by their economic status and caregivers’ willingness to provide care for both rural and urban old people. There is a need for an overall improvement in the planning, provision and financing of long-term care services for elderly individuals in China.

LTC SERVICE UTILIZATION IN ASIAN COUNTRIES: THEORY, PRACTICE AND OUTCOMES

In Asia, provision of LTC care services for elderly is fast emerging with fragmented integration of western approaches to delivering continuum of care services. Limited knowledge exists on utilization or effectiveness of LTC services that incorporate theory to determine service outcomes. In this symposium, presenters will share findings on service utilization from Taiwan, Hong Kong and India. Woven into their discussion is theoretical framework to evaluate service utilization and outcomes using primary data from LTC providers and clients. Liou will discuss findings from interviews (41 staff and 26 clients) in Adult Day Services Centers in Taiwan using the competing values framework of organizational culture for LTC, highlight staff-clients relationship based on clan versus hierarchical culture, and the importance of “didactic relationship’ for positive services outcome for clients. Lu, and colleagues will examine key social determinants of life satisfaction among elders who live alone in urban China using data from 862 older respondents and discuss why social participation; family relationship and preference of living arrangement are considered important protective factors of life satisfaction than dependency on formal community services, and offer ways to improve services for single elders with compromised IADLs and ADLS. Balaswamy will present findings from interviews with 187 residents in Old Age Homes (OAH) in India framed within the Andersen model. She will share the challenges residents have in accessing health care services, enabling factors of service use, affordability to health care which is a primary dilemma for all residents and recommendations for designing and improving LTC services.

Trajectories of long-term care in 28 EU countries: evidence from a time series analysis.

This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users. This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat. The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services. Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.

Long-term care service needs and planning for the future: a study of middle-aged and older adults in Hong Kong

ABSTRACTLong-term care (LTC) planning is important in helping the older people tackle their future needs better. The needs for LTC services represent generational characteristics as they may be different between the current and upcoming cohorts of older adults. However, very few studies have examined the cohort differences in terms of their expected utilisation of LTC services, while understanding the patterns is crucial in helping policy makers prepare for the development of LTC services. This study fills the research gap by examining the plans and expectations for LTC services of 1,613 middle-aged and older persons in Hong Kong with data collected from a telephone survey. By applying the Andersen Model to examine LTC expectations, this study analyses the LTC needs and plans of the middle-aged and older cohorts of Hong Kong adults, as well as their associated factors, with a multiple logistic regression method. Both gender and birth cohort were examined individually and in combination. Birth cohort and gender have been found to exert an impact on all aspects of LTC needs and planning to varying degrees. The findings are interpreted and contrasted with those of a key study based in the West, with reference to the contextual characteristics of Hong Kong. This study furthers the scholarly understanding on LTC needs and planning and their cohort effect, and draws evidence-based recommendations for LTC development in Hong Kong, a rapidly ageing East Asian society.

Policy Dilemmas in Financing Long‐term Care in Europe

AbstractLong‐term care (LTC) is the largest insurable risk facing the elderly in most high‐income countries. Paradoxically, institutional responses to the need to insure ex ante (i.e. before the contingency occurs) the financial risks of needing LTC, either through social, private, or self insurance, exhibit limited development. In contrast, mechanisms to finance LTC ex post continue to develop, primarily those supported by the public sector (i.e. subsidies or tax deductions) and the family (i.e. intergenerational transfers). Both ex ante and ex post types of financing mechanisms are found to be subject to shortcomings which give rise to dilemmas for public policy. Governments confront these dilemmas in different ways, causing a great deal of heterogeneity in the financing and provision of LTC services across Europe.

The Computer Competency of Nurses in Long-Term Care Facilities and Related Factors

It is important for nurses who work in long-term care facilities (LTCFs) to have an adequate level of computer competency due to the multidisciplinary and comprehensive nature of long-term care services. Thus, it is important to understand the current computer competency of nursing staff in LTCFs and the factors that relate to this competency. To explore the computer competency of LTCF nurses and to identify the demographic and computer-usage characteristics that relate significantly to computer competency in the LTCF environment. A cross-sectional research design and a self-report questionnaire were used to collect data from 185 nurses working at LTCFs in Taipei. The results found that the variables of the frequency of computer use (β = .33), age (β = -.30), type(s) of the software used at work (β = .28), hours of on-the-job training (β = -.14), prior work experience at other LTCFs (β = -.14), and Internet use at home (β = .12) explain 58.0% of the variance in the computer competency of participants. The results of the present study suggest that the following measures may help increase the computer competency of LTCF nurses. (1) Nurses should be encouraged to use electronic nursing records rather than handwritten records. (2) On-the-job training programs should emphasize participant competency in the Excel software package in order to maintain efficient and good-quality of LTC services after implementing of the LTC insurance policy.

A Budget Proposal for China’s Public Long-Term Care Policy

ABSTRACTLong-term care (LTC) policy is at an experimental stage in China, characterized by various regional pilot programs. The public cost of LTC is difficult to estimate due to a lack of clarity about policy detail from the central government. This article analyzes the current disabled status for vulnerable older people without sufficient financial resources and family supports. It focuses on estimating a safety net public subsidy policy for LTC services in China, both for today and into the future, using China Health and Retirement Longitudinal Survey (CHARLS) data, 2011 wave, with the methods of multinomial logistic regression and simulation. The key contribution is to estimate the future disability trend and LTC public cost based on changes in education, population ageing, and urbanization. Disability prevalence might be decreasing partly due to higher education, urbanization, and better health care, and the overall public LTC costs might be growing by the results of projection.

Targeted Population Health Management for Under 55-Year-Olds Qualifying for LTC Services.

Targeted Population Health Management for Under 55-Year-Olds Qualifying for LTC Services.