Types Of Long-term Care Services Research Articles

민영치매보험의 현물급부에 대한 이용 및 이용 의향에 대한 영향요인 분석

This study empirically analyzed the influencing factors on the use and intention to use dementia treatment for dementia patients. Research data were collected through an online survey, and the study subjects were 300 dementia patients (N=300). As the result of logistic regression analysis, as the treatment place was a medical institution, the more types of long-term care services currently in use, the longer the elapsed time since the first diagnosis of dementia, the higher the use and intention to use speech therapy services. As the dementia patient was male, the more types of long-term care services currently in use, and the higher the elderly long-term care level, the higher the use and intention to use brain stimulation therapy services. As the guardian of the dementia patient was male, the use and intention to use the emergency monitoring service were higher. The results of this study can be usefully used for developing in-kind benefits for private dementia insurance and for marketing activities. It is expected to contribute to the strengthening of the social safety net of private insurance , the development of the healthcare industry, and diminishing social costs through the vitalization of dementia-related in-kind benefits.

The relationship between family and residential settings: Aging in place vs long term care facility in South Korea

Objective: This study aims to explore the factors influencing long-term-care beneficiaries’ decisions between home health care and institutional care in South Korea. This study further investigated the association between these two types of long-term care services and emotional, financial, and physical burden alleviation among the beneficiaries and their family members. Methods: We analyzed data from 2019 Long-Term Care Survey. Out of 5,606 respondents, 4,079 long-term care beneficiaries and family members were included in this study. Logistic regression models were conducted to understand factors associated with types of long-term care services, and the association between types of long-term care services and burden alleviation. Results: Having a spouse, having children, or a shorter geographic distance between the beneficiaries and their family members were factors associated with higher likelihood of receiving home health care rather than institutional care. Also, more sever mobility limitation, outpatient care, and fall experiences were associated with higher likelihood of receiving institutional care. Utilization of institutional care was significantly associated with higher alleviation of physical burden. No significant differences between home health care and institutional care were found on emotional and financial burden alleviation. Conclusions: The findings suggest that family resources may be beneficial for older adults to pursue aging in place in later life. However, the physical toll of their family members may exist. Our findings provide evidence to inform public policy decisions on long-term care services for older adults and their family members.

Adult Day Service Use among Ethnic Minority Older Adults: An Updated Integrative Review

Adult day services (ADS) are a preferred care option for racial and ethnic minorities compared to other types of long-term care services in the United States. However, there is limited knowledge on minority ADS users. Focusing on minority older adults, this study aims to (a) identify facilitator and barriers of ADS use, and (b) examine ADS’s effect on health and wellbeing. Using Whittemore and Knafl’s methodology of integrative reviews, we searched relevant studies published between 2010 to 2020 in Ageline, PubMed, PsycINFO, CINAHL, Web of Science and Google Scholar and included 8 articles in this review after extensive screening and critical appraisal. Crowe Critical Appraisal Tool (CCAT) was used to assess methodological rigor of the studies included in this review. This review showed that individual factors of ADS use among minority older adult included functional impairment, diabetes, race, gender, and degree of loneliness. Organizational characteristics, such as availability of transportation services, bilingual nurses, peer support, and cultural activities, and structural factors including for-profit status and source of payment were also related to ADS use among minority older adults. Positive outcomes associated with ADS use were improved quality of life and sense of fulfillment. Better understanding of minority older adults’ experience with ADS will help tailor the services to better fit their cultural preferences and needs. Future research should move beyond individual-level factors to identify and address organizational and structural factors such as institutional structure, organization culture and practice impact on disparities and discrimination in services access and quality.

Municipal long-term care workforce supply and in-home deaths at the end of life: Panel data analysis with a fixed-effect model in Japan.

The study assessed the association between boosting the workforce supply by types of long-term care services and in-home deaths among older people at the municipality level. A fixed-effect panel data analysis was conducted using administrative data for every 3 years from 2008 to 2014. The outcome was the proportion of home deaths, excluding those due to external factors, such as suicide or accident. The explanatory variables were the full-time equivalent numbers of care workers engaged in in-home services, day services, short-stay services, and long-term care facilities per 1000 population aged 65 years and older. Ordinary least squares estimation was conducted, with standard errors corrected for clustering at the prefecture level, adjusting the covariates. Analysis included 1706 municipalities. One care worker increase providing day services per 1000 population aged 65 years and older was associated with a 0.09% increase in the proportion of deaths at home (95% CI: 0.008-0.17). Although statistically non-significant, the number of care workers providing in-home services was positively associated with the proportion of home deaths, whereas the number of those providing short-stay services and providing long-term care facilities and nursing home services were inversely associated with home deaths. Given the increased number of care-dependent older people who opt to stay at home until death, and their informal caregivers who have the burden and stress of care, the findings suggest that policymakers should ensure that the number of care workers for day services is sufficient for supporting care recipients and informal caregivers. Geriatr Gerontol Int 2021; 21: 712-717.

Predictors of Effort-Reward Imbalance Among Employees Providing Three Types of Long-Term Care Services in Japan: Implications for Employee Well-Being.

The purpose of this study was to identify predictive factors of effort-reward imbalance (ERI) among employees in multiple long-term care settings in Japan. This cross-sectional study by convenience sampling included 944 participants providing three types of long-term care: home-based (n = 201), community-based (n = 128), and institutional (n = 615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI. Low job satisfaction, being a care manager, holding a position of department head, working long hours, and having family-related stress were the common factors associated with ERI in employees across all three types of long-term care setting. Long-term care providers should consider the needs of care recipients and their family, as well as the needs of care employees, maximizing rewards so that turnover can be reduced and the diversity of individual work-family needs can be accommodated across multiple forms of long-term care settings.

The impact of different patterns of home- and community-based services on nursing home admission: National data from Taiwan.

This study had two aims: (a) to identify the different patterns of use of home- and community-based services (HCBS) among older adults in Taiwan, and (b) to examine the effects of the different use patterns on HCBS recipients' use of institutional long-term care services. The study analyzed cohort data from Taiwan's first National 10-Year Long-Term Care Plan database and from National Health Insurance Claim Data. We extracted baseline information on older adults who were first evaluated for and prescribed HCBS from 2010 through 2013 (N=71,260). We used latent class analysis to specify the underlying subgroups of recipients with similar patterns of HCBS use. We used hierarchical multinomial logistic regression to examine the effect of the different use patterns on the risk of institutional (e.g., nursing home) placement from 4 to 15 months after initial HCBS evaluation. Four subgroups of HCBS recipients were identified, with patterns of home-based personal care (PC), home-based personal care and medical care (PC/MC), home-based medical care (MC), and community care services. Compared to the home-based PC/MC group, people in the home-based MC group had lower risk (OR=0.54) and people in the community care group had higher risk (OR=1.76) of admission to a nursing home. Study findings may provide insights for policy makers regarding the usefulness of integrating medical care and other types of long-term care services into adult day care.

Predictors of Effort-Reward Imbalance Among Employees Providing Three Types of Long-Term Care Services in Japan

Increasingly, employees are leaving their jobs as long-term care workers in Japan. The purpose of this study was to identify predictive factors of effort-reward imbalance (ERI) among employees in long-term care, to better understand factors associated with excessive effort and reduced reward. This cross-sectional study included 944 participants providing three types of long-term care: home-based (n=201), community-based (n=128), and institutional (n=615). Multiple logistic regression analysis was used to identify factors associated with self-reported ERI, where higher ERI scores indicated greater work-related efforts and lower rewards. Key independent variables included type of occupation, employment status, position, daily working hours, job satisfaction, and annual income. Our results showed that low job satisfaction was the sole common factor associated with ERI in employees across all three types of long-term care. Other predictive factors for ERI differed by type of long-term care services. Working longer hours predicted ERI in community-based and institutional care employees, but not home-based care employees. For institutional care employees, being a care manager, holding a position of department head, having family-related stress were risk factors for ERI, suggesting that in this setting, the rewards of higher income and more prestige in leadership positions are offset by greater work-related demands. In conclusion, factors associated with ERI were both common and distinct among employees providing different types of long-term care services. Adjusting work demands and working hours, and identifying unique contributors to ERI within specific long-term care settings may help with job retention in these occupations.

Disparities in the Access to Different Types of Long-Term Care Services in Taiwan

Taiwan implemented version 1.0 of its 10-Year Long-Term Care Plan (TLTCP 1.0) in 2007, and version 2.0 (TLTCP 2.0) in 2017. The aim was to develop a system of home- and community-based services (HCBS) for long-term care (LTC). This study assessed and compared disparities in access to LTC services using one county’s database that claims made by 14,051 older adults who applied for LTC services from TLTCP 1.0 (n = 5,025) and TLTCP 2.0 (n = 9,026). We assessed LTC disparities related to five sociodemographic factors (age, gender, living status, urbanization, income status) and seven types of LTC services. Older adults who lived in a city were more likely to use multiple HCBS and transportation services. Older adults who lived alone were more likely to use home care and meal services but not other types of LTC services. All disparities in service use increased from TLTCP 1.0 to TLTCP 2.0. Part of a symposium sponsored by International Comparisons of Healthy Aging Interest Group.

Place of death associated with types of long-term care services near the end-of-life for home-dwelling older people in Japan: a pooled cross-sectional study

BackgroundMany older people wish to die at home. However, there is still a huge gap between the place where older adults wish to die and the place where they, in fact, do die. We aimed to assess the association between each type of long-term care (LTC) services that home-dwelling older individuals utilized at their end of life and place of death.MethodsA pooled cross-sectional study at the point of death was used for the analysis. Participants included beneficiaries of long-term care insurance in Japan, aged 65 years and above, who passed away between January 2008 and December 2013, excluding those who died due to external factors and those who were using residential services at their time of death. We conducted a multivariate Poisson regression analysis with robust standard errors adjusting for potential confounders and examined the association between the use of each type of LTC service for home-dwelling recipients, including in-home services, day services, and short-stay services, with the interaction terms being time of death (exposure) and home death (outcome). We calculated the adjusted probability of home deaths for each combination pattern of LTC services for home-dwelling recipients using standard marginalization.ResultsWe analyzed 2,035,657 beneficiaries. The use of in-home services, day services, and short-stay services were associated with an increased probability of home deaths; the incident rate ratio (IRR) was 13.40 (with a 95% confidence interval (CI): 13.23–13.57) for in-home services, the IRR was 6.32 (6.19–6.45) for day services, and the IRR was 1.25 (1.16–1.34) for short-stay services. Those who used day or short-stay services with in-home services exhibited a higher probability of home deaths than those who used only day or short-stay services.ConclusionsWe demonstrated that home-dwelling older persons who used LTC services near end-of-life had a higher probability of home deaths as compared to those who did not. Our findings can clarify the importance of providing and integrating such services to support care recipients who wish to die at home as well as for the benefit of their informal caregivers.

DISPARITIES IN ACCESSING DIFFERENT TYPES OF LONG-TERM CARE SERVICES IN TAIWAN

A growing body of evidence documents pervasive social and demographic factors relating to disparities in long-term care (LTC). In 2007, Taiwan implemented its Ten-year Long-Term Care Plan version 1.0 (TLTCP 1.0) that aimed to develop a home-and community-based (HCBS) LTC system. In 2016, Taiwan began to implement TLTCP 2.0. To continue providing effective LTC, this study aimed to assess the disparities in access to LTC services using Taiwan’s LTC claim database from 2010 to 2013. A total of 87,438 older adults who had applied for LTC services from the TLTCP 1.0 were included. The study assessed LTC disparities related to five sociodemographic factors, including age, gender, living status, urbanization, and income status. Sixteen types of LTC services, including HCBS, home-based professional care, meal services, transportation, and institutional services were assessed. After controlling for the level of disability, we found that those who were older-old (age 80> over), male, and low-income were less likely to use HCBS, but more likely to use institutions services (p < 0.001). We also found that those who lived in the city were more likely to use HCBS and transportation services (p < 0.001). Yet, older adults living alone were more likely to use home care and meal services but not other types of LTC services (p < 0.001). In conclusion, the social disparities in access to LTC services in Taiwan remains, suggesting LTC 2.0 should continue monitoring and placing the LTC equity issue on the top priority.

Incidence of hip fracture among long-term care insurance beneficiaries with dementia: comparison of home care and institutional care services

BackgroundHip fracture among older adults is not only a major health issue but also preventable by providing proper care, but there is a lack of studies on the association between type of long-term care (LTC) service and hip fracture. This study aimed to investigate the association between the type of LTC service and the incidence of hip fracture among older adults with dementia receiving long-term care insurance (LTCI), and to investigate how such association differs according to characteristics of beneficiaries and structural characteristic of institutional care.MethodIn this retrospective cohort study, data from 2008 to 2013 were collected from 7112 LTCI beneficiaries having benefit level 1 or 2 with dementia aged 60 years or over in the Korean elderly cohort data set. Type of LTC service was categorized into institutional or home care using the LTCI Claims Database, and the incidence of hip fracture was used as the outcome variable. A survival analysis using a time-dependent Cox regression analysis was performed to examine the association between time-varying LTC service type and hip fracture.ResultsOf the 7112 older adults, 115 (1.6%) had hip fracture during a total of 16,540 person-years. Compared to LTC beneficiaries with home care, those with institutional care had a higher adjusted hazards ratio of incidence of hip fracture (hazards ratio = 4.33, 95% confidence interval, 2.84–6.59). This association was particularly strong among beneficiaries who did not have a danger of hip fracture during the mandatory assessment for benefit eligibility, who were partially ambulatory, who were from rural areas, and females.ConclusionsInstitutional care was more likely associated with a higher incidence of hip fracture than home care. The government need to watch the institutional LTC services quality and promote improvements of the institutional care quality.

Long-term care in the health system: European tendencies and Bulgarian experience

Introduction: One of the most serious challenges faced by health systems in the world is the population ageing, which stresses the increasing importance of long-term care. This article aims at providing a concise definition of long-term care, the kinds of services included in it, the trends in the long-term care costs and the scope of the services, as well as the various financial arrangements for long-term care. Materials and methods: This is a review article, which summarizes the findings in the literature concerning the content and scope of the concept „long-term care`. An attempt has been made to give a short classification of the types of long-term care services and their financing. The paper is based on materials, analyses and statistical data by the Organization of Economic Cooperation and Development (OECD), the European Union and Bulgarian sources. Results and Discussion: The term „long-term care` refers to a range of services provided for people with limited ability (physical and/or mental) to function who therefore depend on an outside assistance for meeting various needs (medical and nonmedical) for an extended period providers. The share of long-term care health costs in GDP and in total health costs varies significantly across the EU member-states. It is substantially lower in the new Central and Eastern European members, among which Bulgaria ranks last. EU countries can be grouped on different dimensions to deliver a typology of long-term care systems, some of the classifications being presented in the article. Conclusion: The long-term care system faces a number of challenges, connected with the increasing costs parallel with the rising expectations for a higher quality and efficiency. A challenge in every country, even the most developed one, is the provision of the adequate number and qualification mix of formal carers as well as various types of assistance for the informal carers - financial, information, consultative and psychological.

Incidence of Pressure Ulcers During Home and Institutional Care Among Long-Term Care Insurance Beneficiaries With Dementia Using the Korean Elderly Cohort

ObjectiveTo assess whether type of long-term care service is a risk factor of the incidence of pressure ulcers among older adults with dementia who are receiving long-term care insurance (LTCI). MethodsData from LTCI beneficiaries (benefit level 1 or 2) with dementia, aged 60 and older (n = 7841), in the Korean Elderly Cohort data set from 2008 to 2013 were used. Type of long-term care service was categorized into home or institutional care using the LTCI Claims Database. The National Health Insurance Claims Database was used to identify the incidence of pressure ulcers as the outcome variable in a survival analysis using the time-dependent Cox proportional hazard model. ResultsOf the 7841 participants, 98 (1.2%) exhibited pressure ulcers. Compared with beneficiaries receiving home care, those receiving institutional care had a higher adjusted hazard ratio for pressure ulcers (hazard ratio 6.48, 95% confidence interval 3.48–10.86). These associations were particularly strong among beneficiaries without pressure ulcers during the mandatory assessment for benefit eligibility and who were partially ambulatory. DiscussionBeneficiaries receiving institutional care were more likely to have pressure ulcers than were those receiving home care. The government must monitor the quality of institutional long-term care services and encourage service providers to improve such care.

The Impact of Private Long-Term Care Insurance on the Use of Long-Term Care

This paper investigates the effects of privately purchased long-term care insurance (LTCI) on three major types of long-term care services: nursing home care, paid home care, and informal care received from Family and friends. Using 2002-2008 data from the ongoing Health and Retirement Study, we analyze the determinants of long-term care utilization simultaneously with the determinants of holding LTCI. We find that LTCI has modest effects on the likelihood of using long-term care services. For the very frail elderly, private LTCI enhances their access to nursing home care. For those with moderate disability, LTCI makes it more likely that they can remain at home and receive home care services, instead of going to a nursing home. We find no evidence that formal care substitutes for informal care in the presence of LTCI. These findings suggest that if LTCI becomes much more prevalent in the future, many older adults will be able to choose the type of long-term care arrangement that best suits their needs.

Relationship between home care service use and changes in the care needs level of Japanese elderly

BackgroundWith the introduction of long-term care insurance (LTCI) in Japan, more home care services are available for the community-dwelling elderly. To deliver effective home care services, it is important to know the effects of service use. In this study, as the first step to determine this, we sought to describe different home service use in the sustained/improved group and deteriorated group in their care needs levels, and to report the relationship between the use of home care services and changes in care needs levels.MethodsThe participants included 624 of a total of 1,474 users of LTCI services in one city in Japan. Home care service users were stratified into a 'lower care needs level subgroup' and a 'higher care needs level subgroup' based on the baseline care needs level. Simple statistical comparison and multiple logistic regression analyses in which the change in care needs level was set as a dependent variable were performed. Gender, age, and baseline care needs level were designated as control variables. Home based services were treated as independent variables. In this study, home care services consisted of home help, home bathing services, a visiting nurse, home rehabilitation, nursing home daycare, health daycare, loan of medical devices, respite stay in a nursing home, respite stay in a health care facility, respite stay in a sanatorium-type medical care facility, and medical management by a physician.ResultsIn the lower care needs level subgroup, age (OR = 1.04, CI, 1.01-1.08), use of respite stay in a nursing home (OR = 2.55; CI, 1.43-4.56), and the number of types of long-term care services (OR = 1.33; CI, 1.02-1.74) used during an 11 month period were significantly related to a deterioration of the user's care needs level. In the higher care needs level subgroup, use of medical management by a physician (OR = 6.99; CI, 1.42-41.25) was significantly related to a deterioration of the user's care needs level. There were no home based services significantly related to sustaining or improving the user's care needs level.ConclusionThere were different home service use in two groups (the sustained/improved group and the deteriorated group). Respite stay in a nursing home service use and more types of service use were related to experiencing a deterioration of care needs level in lower care needs level community-dwelling elderly persons in Japan. Further, medical management by a physician service was related to experiencing a deterioration of care needs level in higher care needs level community-dwelling elderly persons.

Factors Affecting the Long-Term Care Preferences of the Elderly in Taiwan

This study sets out to investigate the preferences of the elderly in northern Taiwan with regard to various types of long-term care services. Taking into consideration sociodemographics, health condition, and access to such medical care services, our study examined both economic and family factors in an attempt to gain an understanding of the knowledge of and attitudes toward, the various types of long-term care among the elderly. An interview survey was carried out by local public health nurses among a sample of 562 elderly Taiwanese residents (people aged 65 years or older) from 7 counties/cities in northern Taiwan, all of whom had been selected by means of multistage sampling. The survey was conducted using a questionnaire based on the Andersen and Newman model of health care utilization, with the intention being to gain a better understanding of the related factors. The results indicate that both ethnic background and the requirement for additional medical care services had significant effects on the long-term care preferences of the elderly in Taiwan, a finding that should help to provide a better understanding of the preferences for and availability of such long-term care services among the elderly. Such improved understanding could result in improving the quality of life for the elderly, particularly if they feel that their preferences have been taken into consideration and their needs have ultimately been met.

Depression recognition and treatment in long-term care: future directions

With the rapid aging of the Western society, it is not surprising that the use of long-term care (LTC) services is expected to increase in future years. Whereas in 2000, 13 million Americans used at least one type of LTC service, this number is expected to more than double by 2050 [101]. The characteristics of LTC vary dramatically, with some LTC services being institutionally based (e.g., nursing homes, assisted living facilities and skilled nursing care), whereas others are

Sidebar: Long-term care is an important consideration in financial planning for later life

Sidebar: Long-term care is an important consideration in financial planning for later life

치매노인의 서비스 희망과 이용의 일치 여부에 영향을 미치는 요인

Korean government is preparing the long-term care financing and delivery system in order to cope with rapid population aging. The system should be designed to provide demented patients with an appropriate services that the patients want to take, and considered to be necessary for them. In this regard, this study aims to analyse empirically a relationship between the types of long-term care services that demented patients wanted to take and they actually received during 2004. The caregivers of 609 dementia patients, who were randomly selected in a manner of proportional allocation from a nationwide claim database of the Korean National Health Insurance Corporation, were interviewed in September, 2005. Independent variables include socio-demographic characteristics, Activities of Daily Living(ADL) and Instrumental Activities of Daily Living(IADL). To explore the correspondence of the types of long-term care services that demented patients wanted to take and that they actually received, and its affecting factors, we conducted chi-square test and logistic regression analysis. Main findings are as follows. First, while only 20% of study subjects wanted home services as a long-term care services, those who wanted to use the long-term care facilities and general hospital were 37%, 43% respectively. Second, the correspondence rate was just 38% on average, and extremely low in the demented patients who wanted to use long-term care facilities. Third, the demented patients who resided in urban areas and received relatively high level of education showed high correspondence rate. Fourth, the high ADL score was closely related to low correspondence rate.

Exploring the Associations Between Long-Term Care and Mortality Rates Among Stroke Patients

Information on types of long-term care received by stroke patients after hospital discharge is essential for the formulation of long-term care resource development policy. Comparisons of outcomes resulting from different types of long-term care can provide important considerations in the selection of long- term care services. The purpose of this study is to describe the patterns of long-term care received, and to explore if associations exist between long-term care services and mortality status among stroke patients after hospital discharge. Using a longitudinal quasi-experimental study design, this study collected information on the type of long-term care received at 1, 3, and 6 months after discharge for 714 patients. At one month after discharge, 4.5 % had died, and 22.1 % had regained all functions in activities of daily living and instrumental activities of daily living. The percentage of patients receiving institutional care, home or community-based care, and family care only were 10.4 % , 22.4 % , and 40.7 % respectively. The respective percentages at 3 months after discharge were 11.2 % , 18.7 % , and 38.0 % , and, at 6 months after discharge, 10.3 % , 19.4 % , and 30.9 % . After adjusting for age, sex, previous incidence of stroke, and physical functions, the odds of dying within 6 months after discharge for stroke patients receiving home or community-based care was significantly lower than those in institutions ( OR = 0.39; 95 % CI = 0.15 to 0.97 ). It is not clear why a lower mortality rate was observed among patients receiving home or community-based services. Differences in quality of care and quality of life among users of different types of long-term care services should be investigated. More research is needed to assess the causes of the disparity in mortality rates among users of different types of long-term care services.