LTC Services Research Articles

노인장기요양보험 이용지원 상담 대상자 선정모형 개발

In the long-term care insurance (LTCI) system, National Health Insurance Service (NHIS) provide counseling services for beneficiaries and their family caregivers, which help them use LTC services appropriately. The purpose of this study was to develop a Target Selection Model for the Counseling Services based on needs of beneficiaries and their family caregivers. To develope models, we used data set of total 2,000 beneficiaries and family caregivers who have used the long-term care services in their home in March 2013 and completed questionnaires. The Target Selection Model was established through various data-mining models such as logistic regression, gradient boosting, Lasso, decision-tree model, Ensemble, and Neural network. Lasso model was selected as the final model because of the stability, high performance and availability. Our results might improve the satisfaction and the efficiency for the NHIS counseling services.

Providing Rural Care, Remotely: Avera’s eCare Initiative

Providing Rural Care, Remotely: Avera’s eCare Initiative

Community-Based Long-Term Care Services: If We Build It, Will They Come?

This study examines the relationship between caregivers' perception of community-based long-term care (CBLTC) services and the service use. We used first two waves of the longitudinal data set of 1,416 dyads of care recipients and their caregivers in Singapore. Four perceived attributes of LTC services--service quality, convenience, social connectedness, and affordability--were measured on a 5-point scale. Among the four perceived attributes, perceived affordability was significantly associated with future utilization for all types of CBLTC services. Perceived service quality and convenience was significantly associated with center-based LTC services use. Caregivers are critically involved in the decision of using CBLTC services, and their perception of service characteristics is significantly associated with the uptake of CBLTC services. It is important to incorporate both care recipients' and caregivers' needs and preferences when designing and promoting integrated health care delivery models.

Smoking Linked to Many More Causes of Death

Smoking Linked to Many More Causes of Death

Japanese Social Expenditure under Rapid Population Ageing

Japan is suffering from low fertility for more than two decades, and Japanese social security system needs a structural reform to be more effective and sustainable. In this paper, we discussed structural issues in the Japanese social security system, which will provide the basis for containing social expenditure in Japan. Some Japanese benefits, such as child-rearing support and benefit for low income families as well as long-term care benefit, need to be increased. On the other hand, it is important to incorporate right incentives in the system for healthcare and LTC services, and new forms of solidarity are indispensable to make Japanese social security system sustainable.

Inequity in long-term care use and unmet need: Two sides of the same coin

We investigate the determinants of several LTC services and unmet need using data from a representative sample of the non-institutionalised disabled population in Spain in 2008. We measure the level of horizontal inequity and compare results using self-reported versus a more objective indicator of unmet needs. Evidence suggests that after controlling for a wide set of need variables, there is not an equitable distribution of use and unmet need of LTC services in Spain; formal services are concentrated among the better-off, while intensive informal care is concentrated among the worst-off. The distribution of unmet needs for LTC services depends on the service considered and on whether we focus on subjective or objective measures. In 2008, only individuals with the highest dependency level had universal coverage. Our results show that inequities in most LTC services and unmet needs among this group either remain or even increase for formal services.

Evaluation of an integrated system for classification, assessment and comparison of services for long-term care in Europe: the eDESDE-LTC study

BackgroundThe harmonization of European health systems brings with it a need for tools to allow the standardized collection of information about medical care. A common coding system and standards for the description of services are needed to allow local data to be incorporated into evidence-informed policy, and to permit equity and mobility to be assessed. The aim of this project has been to design such a classification and a related tool for the coding of services for Long Term Care (DESDE-LTC), based on the European Service Mapping Schedule (ESMS).MethodsThe development of DESDE-LTC followed an iterative process using nominal groups in 6 European countries. 54 researchers and stakeholders in health and social services contributed to this process. In order to classify services, we use the minimal organization unit or “Basic Stable Input of Care” (BSIC), coded by its principal function or “Main Type of Care” (MTC). The evaluation of the tool included an analysis of feasibility, consistency, ontology, inter-rater reliability, Boolean Factor Analysis, and a preliminary impact analysis (screening, scoping and appraisal).ResultsDESDE-LTC includes an alpha-numerical coding system, a glossary and an assessment instrument for mapping and counting LTC. It shows high feasibility, consistency, inter-rater reliability and face, content and construct validity. DESDE-LTC is ontologically consistent. It is regarded by experts as useful and relevant for evidence-informed decision making.ConclusionDESDE-LTC contributes to establishing a common terminology, taxonomy and coding of LTC services in a European context, and a standard procedure for data collection and international comparison.

Effect of in-home and community-based services on the functional status of elderly in the long-term care insurance system in Japan

BackgroundJapan is setting the pace among aging societies of the world. In 2005, Japan became the country with the highest proportion of elderly persons in the world. To deal with the accelerated ageing population and with an increased demand for long-term care services, in April 2000 the Japanese government introduced a mandatory social Long-Term Care Insurance System (LTCI), making long-term care services a universal entitlement for elderly. Overseas literature suggests that the effectiveness of a home visiting program is uncertain in terms of preventing a decline in the functional status of elderly individuals. In Japan, many studies regarding factors associated with LTC service utilization have been conducted, however, limited evidence about the effect of LTC services on the progression of recipient disability is available.MethodsData were obtained from databases of the LTC insurer of City A. To examine the effect of in-home and community-based services on disability status of recipients, a survival analysis in a cohort of moderately disabled elderly people, was conducted.ResultsThe mean age of participants was 81 years old, and females represented 69% of the participants. A decline or an improvement in functional status, was observed in 43% and 27% of the sample, respectively. After controlling for other variables, women had a significantly greater probability of improving their functional status during all phases of the observation period. The use of “one service” and the amount of services utilized (days/month), were marginally (p = < 0.10) associated with a greater probability of improving their functional status at 12 months into the observation period.ConclusionsThe observed effects of in-home and community-based services on disability transition status were considered fairly modest and weak, in terms of their ability to improve or to prevent a decline in functional status. We suggest two mechanisms to explain these findings. First, disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients. Secondly, in-home and community-based services provided in City A, may be inappropriate in terms of intensity, duration or quality of care.

Quality Assurance Policies and Indicators for Long-Term Care in Estonia

An assessment of quality assurance policies in LTC in Estonia finds in general that much progress has been achieved in creating and monitoring the quality of inputs of services (infrastructure, personnel, planning and funding). Some attempts have been made to evaluate the processes of LTC services, but almost nothing is found about the evaluation of the results.One problem is that quality monitoring is not yet developed, but some steps towards routine monitoring and publishing the results have been included in future plans of social and health care in Estonia. Also, quality-related databases are expected to be improved and published, which allows patients and clients to find the best practices according to their needs.

The Supercommittee Stirs LTC-Policy Pot

The Supercommittee Stirs LTC-Policy Pot

Predictors of the highest long-term care expenditures in Japan.

BackgroundIn Japan, as the number of elderly covered by the Long-term Care Insurance (LTCI) system has increased, demand for long-term care services has increased substantially and consequently growing expenditures are threatening the sustainability of the system. Understanding the predictive factors associated with long-term care expenditures among the elderly would be useful in developing future strategies to ensure the sustainability of the system. We report a set of predictors of the highest long-term care expenditures in a cohort of elderly persons who received consecutive long-term care services during a year in a Japanese city.MethodsData were obtained from databases of the LTC insurer of City A in Japan. Binary logistic regression was used to examine the predictors of the highest long-term care expenditures. We used a simplified model that focused on the effects of disability status and type of services used, while controlling for several relevant factors. Goodness of fit, a multicollinearity test, and logistic regression diagnostics were carried out for the final model.ResultsThe study cohort consisted of 862 current users of LTCI system in city A. After controlling for gender and income, age, increased utilization rate of benefits, decline in functional status, higher care needs level and institutional care were found to be associated with the highest LTCI expenditures. An increased utilization rate of benefits (OR = 24.2) was a strong main effect predictors of the high LTC expenditures. However, a significant interaction between institutional care and high care need level was found, providing evidence of the combined effect of the two covariates.ConclusionsBeyond to confirm that disability status of elderly persons is the main factor driving the demand of LTC services and consequently the expenditures, we showed that changes in utilization rate of benefits -a specific insurance factor- and the use of institutional care conditional on the high care level, were strongest predictors of the highest LTC expenditures. These findings could become crucial for tracking policies aimed at ensuring financial sustainability of LTCI from a public insurer perspective in Japan.

Long Term Care in Romania

The increasing life expectancy and the alarming growth in the incidence of chronic illness make long term care services in high demand and in dire need of change and innovation. As part of the ANCIEN initiative, which aims to comprise a database of European approaches for dealing with long term care, this document creates an overview of the health systems organized in Romania which target individuals with long term care needs. The method of governance, the people’s needs and the available services are presented herein. For the most part, the services provided in this field are covered through the efforts of the family of those in need and are therefore difficult to quantify or analyze. Public services are either insufficient (in terms of quality or accessibility) and the moral stigma associated to using them prevents families from making this choice. However, due to a high demand and a low supply of high quality LTC services, the private market of nursing homes has exploded in the last few years, funded either privately, through NGOs or external donations. The quality and number of available services has greatly improved but the accessibility is still low. At this moment, Romania still does not have an integrated long term care system neither from the legal or the organization of services being offered. There are social and medical services that are run, provided and legislated independently. The current national strategy is to coordinate these services and to create an integrated system with multidisciplinary teams which would include different types of medical specialists and nurses but still maintain and improve the services offered formally or informally as a home based care package.

The System of Long-Term Care in Poland

In the field of social protection, Poland belongs to the EU group of countries with the family-based welfare model, what is extremely visible for the long-term care where family is the main care provider for elderly individuals with limitations in activities of daily living. At the same time the proportion of elderly in the coming decades is projected to be among the highest in the European Union, what raises questions on the design of the long-term care. For the moment the system is highly unregulated and disintegrated between social assistance and health care services. But it is the health sector that concentrates policy debate with a proposal of an introduction of nursing insurance. In the social sector, the significant changes that were favorable to LTC services development were introduced by the law on the social assistance (2004) and family benefits (2003) widening the scope of care available at home and in adult day care centers. But still provision of services is insufficient and a market of private services, paid out-of-pocket rapidly develops. It seems that main problems of the long-term care development in the future will be raising demand against insufficient resources and diversified priorities of the health care system.

The Lithuanian Long-Term Care System

The remarkable growth of older population has moved long-term care to the front ranks of the social policy agenda in the European Union. This paper addresses the issue of the longterm care in Lithuania, its philosophy, the legal and funding regularities, management issues and LTC policy. Its attempt is also to provide a complex set of information about the demand side of long-term care including the demographic characteristics of people in need. The paper also presents a detailed description of types of LTC available.The results confirm that the main problem of the LTC system in Lithuania is still its division between the health care system and the social system and the weak integration of these two parts of LTC services. The formal LTC system in Lithuania is still biased towards the provision of institutional care, despite the fact that a number of social projects have started in order to expand the supply of semi-stationary LTC and care provided in homes. Moreover, most care provided to the elderly and disabled is still carried out by family, neighbours, friends and volunteers.The demand for LTC, approximated by the demographic and epidemiologic structure of the population at the national and regional levels, remains high and it is expected to increase. The middle-aged population’s longer average lifespan and progress in the field of medicine greatly contributes to an increasing number of disabled and older people who have difficulties in caring for themselves.

데이터마이닝 기법을 활용한 노인장기요양급여 권고모형 개발

노인장기요양보험에서 가장 중요한 이슈는 급여대상자의 희망, 건강 및 기능상태에 따라 어떤 급여를 제공할 것인가 이다. 이를 해결하고자 노인장기요양보험의 보험자인 국민건강보험 공단은 급여대상자에게 '표준장기요양이용계획서'를 제공하고 있다. 본 연구에서는 표준장기요양이용계획 작성의 효율화 방안을 마련하고자 노인장기요양보험 3차 시범사업 표준이용계획 자료를 활용하여 노인장기요양급여 권고모형을 개발하였다. 모형개발에는 데이터마이닝의 의사결정나무모형, 로지스틱회귀모형, 앙상블 모형의 배깅과 부스팅 기법을 사용하였고, 이 중 실무자가 이해하기 쉬운 의사결정나무를 채택하여 권고모형을 설명 하였다. 본 연구는 노인장기요양보험 제도의 이용계획 수립의 객관성 및 과학성을 확보하고 이용계획 업무를 효율화하는 데에 기여할 것으로 기대된다. In the long-term care insurance(LTCI) system, the question of how to provide the most appropriate care has become a major issue for the elderly, their family, and for policy makers. To help beneficiaries use LTC services appropriately to their needs of care, National Health Insurance Corporation(NHIC) provide them with the individualized care plan, named the Long-term Care User Guide. It includes recommendations for beneficiaries' most appropriate type of care. The purpose of this study is to develop a recommending system for care plan(Res-CP) in LTCI system. We used data set for Long-term Care User Guide in the 3rd long-term care insurance pilot programs. To develop the model, we tested four models, including a decision-tree model in data-mining, a logistic regression model, and a boosting and boosting techniques in an ensemble model. A decision-tree model was selected to describe the Res-CP, because it may be easy to explain the algorithm of Res-CP to the working groups. Res-CP might be useful in an evidence-based care planning in LTCI system and may contribute to support use of LTC services efficiently.

LTC Community Wants Inclusion in Reform

LTC Community Wants Inclusion in Reform

Nursing Facility and Home and Community Based Service Need Criteria in the United States

ABSTRACT Over the past two decades states have expanded the delivery of long term care from institutions to the home and community. Although state Medicaid need criteria for the home and community based services (HCBS) waiver program must be equivalent to those for nursing facility (NF) criteria, other screening procedures for these services are not specified. This study examined variations in need criteria, methods for determining need, and assessment forms for NF and HCBS across the states, and identified whether these procedures were more stringent for HCBS than for NFs. The NF minimum need criteria was most often (31 states) based on a combination of nursing, medical, functional, or other psychosocial criteria, 10 states used nursing criteria, and 10 states used limitations in functional activities criteria. The method used for determining need for NF was based on explicit criteria in 25 states, point systems in seven states, and 19 states used guidelines that allowed for judgment by those conducting the assessment. The average length of a NF assessment form was six and one-half pages, which was four pages shorter than the average HCBS form. Within some states the HCBS waivers have higher need criteria, more comprehensive need determination, and longer assessment forms than NFs. Wide variability in screening procedures creates potential inequities to LTC services across the states. Within states, more restrictive screening procedures for HCBS than for NF may limit access to community based long term care.

State Long-Term Care Screening and Assessment Programs

ABSTRACT Long-term care screening and assessment programs were designed by states to controllong-term care costs and to prevent unnecessary institutionalization of Medicaid participants. This study reports data collected by telephone survey of state officials in all 50 states and Washington, D.C. on state variation in LTC screening and assessment programs. The majority of the state screening and assessment programs cover an array of LTC services but this has resulted in multiple separate screening programs for different long-term care services and eligibility groups. Only three states coordinated screening and assessment across long-term care programs by operating a single state administrative agency, using uniform need criteria and standard tools, and having automated databases (Arizona, Colorado, and Maine). The design and implementation of multiple and separate screening and assessment programs in most states may create potential barriers to clientaccess, information about services and choice of services.

Motives for Private Income Transfers

Private income transfers are becoming increasingly recognized as a key aspect of the U.S. economy. The majority of private income transfers occur inter vivos (i.e., between living persons), but very little is known about this type of transfer behavior. This paper tests alternative hypotheses concerning motivation for inter vivos transfers. Two motives are considered: altruism and exchange. Evidence presented here casts doubt on the altruistic model of transfer behavior. Observed patterns for inter vivos transfers are more consistent with exchange-related motives. This finding has important implications for the effects of public transfer programs on the distribution of economic well-being.