Evaluation of home-visit nursing services supply: a multilevel analysis.

科学研究費助成事業(科学研究費補助金)研究成果報告書：若手研究(B)2010-2011課題番号：2279225

Factors Related to Positive Feelings of Caregivers Who Provide Home-Based Long-Term Care for Their Family Members in Japan

Background. The objective is to elucidate the factors related to the positive feelings of family caregivers who are engaged in home-based elderly care. Methods. The study utilized the data of a cross-sectional citywide survey in Japan. The survey was conducted with 1,821 subjects and the final analysis was performed on 435 subjects. Questions for recipients such as those on their care levels, causes of care, whereas the primary caregivers were asked about whether they had positive feelings toward caregiving, and whether their opinion was reflected in care policies. Results. The factors s that showed a positive association with positive feelings were “the caregiver’s opinion is reflected in care policies” (OR: 5.05, 95% CI: 2.60–9.87) and “the caregiver is in good health condition” (OR: 2.02, 95% CI: 1.02–3.93). The factors that showed a negative association were “the caregiver is a daughter-in-law of the care recipient” (OR: 0.42, 95% CI: 0.21–0.82) and “the care recipient is an elderly person with cognitive impairment” (OR: 0.36, 95% CI: 0.18–0.70). Conclusions. The study suggests the necessity of providing support for caregivers in terms of empowerment and health management. Furthermore, they suggest that special attention should be paid to caregivers at risk of being unable to sustain positive feelings toward caregiving

Predictors of preferred location of care in middle-aged individuals of a municipality in Japan: a cross-sectional survey

BackgroundJapan has the highest rate of aging. To contain Long-Term Care (LTC) Insurance costs, the Japanese government is attempting to increase the proportion of individuals receiving home care services. However, demand for institutional care is increasing. These circumstances will decrease the sustainability of the LTC Insurance System. The objective of the present study was to identify predictors of the location of preference for LTC (home or a facility) in middle-aged individuals in a municipality.MethodsThis was a cross-sectional study of middle-aged individuals (n = 906) in Tsukuba, Japan. Data primarily included individual or social factors (sex, age, household size, experience with caring for family, information sources about social services or municipality policy), factors about care prevention (self-reported health, efforts to promote health, motivation in life), and the preferred location of care. These variables were analysed with multiple logistic regression, using preferred location of care as the dependent variable.ResultsA total of 693 respondents were analysed. Of these, 440 (63.5%) preferred home and 253 (36.5%) preferred a facility. The results of logistic regression analysis showed that a preference for facility was significantly associated with female sex, younger age, experience with caring for family, fewer information sources about social services or municipality policies, selecting ‘go to culture lessons/study to satisfy interests’, and not selecting ‘spending time happily with family’ under motivation in life.ConclusionsTo support the selection of receiving home care services, municipalities must consider improving policies that reduce the burdens of present middle-aged caregivers, and promote the provision of care service information from multiple sources

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

<p>Abstract</p> <p>Background</p> <p>With 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.</p> <p>Methods</p> <p>The 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.</p> <p>Results</p> <p>In 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.</p> <p>Conclusion</p> <p>There 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.</p

Characteristics of Home-Visit Nursing Agencies That Closed after the 2012 Fee Revision for Home-Visit Nursing Services: A Nationwide Panel Data Analysis in Japan

Despite the 2012 fee revision raising fees for home-visit nursing services to increase their supply in Japan, 300 to 500 home-visit nursing agencies (VNA) are still being closed annually. This study aims to identify the regional and organizational characteristics of the VNAs that closed after the 2012 fee revision. A longitudinal observational study was conducted using nationwide panel data of VNAs from 2014 to 2017 (N = 6496). Multiple logistic regression models stratified by years of operation were used for the analysis. We identified 821 closed agencies (12.6%). In this study, many important factors related to VNA closures were found. In the less than three years group, there were regional factors (lower aging rate and larger number of clinics) and an organizational factor (higher proportion of users under 40 years of age). In the 3–14 years group, there was a regional factor (larger number of clinics) and organizational factors (smaller number of FTE nurses, smaller number of users per FTE nurse, and smaller number of medical care types that can be provided). In the over 15 years group, there was an organizational factor (smaller number of FTE nurses). The findings provide valuable insights for policymakers in avoiding VNA closures

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

Abstract Background Japan 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. Methods Data 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. Results The 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 =  Conclusions The 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.</p