Changes in long-term care insurance revenue among service providers during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has impacted peoples' health-related behaviors, especially those of older adults, who have restricted their activities in order to avoid contact with others. Moreover, the pandemic has caused concerns in long-term care insurance (LTCI) providers regarding management and financial issues. This study aimed to examine the changes in revenues among LTCI service providers in Japan during the pandemic and analyze its impact on different types of services. METHODS: In this study, we used anonymized data from "Kaipoke," a management support platform for older adult care operators provided by SMS Co., Ltd. Kaipoke provides management support services to more than 27,400 care service offices nationwide and has been introduced in many home-care support offices. The data used in this study were extracted from care plans created by care managers on the Kaipoke platform. To examine the impact of the pandemic, an interrupted time-series analysis was conducted in which the date of the beginning of the pandemic was set as the prior independent variable. RESULTS: The participating providers were care management providers (n = 5,767), home-visit care providers (n = 3,506), home-visit nursing providers (n = 971), and adult day care providers (n = 4,650). The results revealed that LTCI revenues decreased significantly for care management providers, home-visit nursing providers, and adult day care providers after the COVID-19 pandemic began. The largest decrease was an average base of USD - 1668.8 in adult day care. CONCLUSION: The decrease in revenue among adult day care providers was particularly concerning in terms of the sustainability of their business. This decrease in revenue may have made it difficult to retain personnel, and staff may have needed to be laid off as a result. Although this study has limitations, it may provide useful suggestions for countermeasures in such scenarios, in addition to support conducted measures.

[Validation of using disqualification from long-term care insurance registry as a proxy of death].

Objectives　The national database for long-term care insurance (LTCI) of Japan (Kaigo DB) enables researchers to access comprehensive data from its LTCI registry, eligibility assessment records, claims for service usage, and information about service providers. However, studies regarding the death or mortality of beneficiaries cannot be conducted because Kaigo DB does not contain death records, and researchers are not allowed to link Kaigo DB to other databases, such as national death records. Therefore, we aimed to assess the validity of using an insurer's disqualification from an LTCI beneficiary as a proxy of death.Methods　We used 510,751,798 monthly beneficiary records between April 2007 and March 2017 from the LTCI registry, while excluding data for ineligible persons for LTCI benefit or those younger than 65 years. We identified insurer cases disqualified from LTCI beneficiaries and linked them to national death records using deterministic linkage methods by dates of birth and death, sex, and residence. We considered the cases as positive if they were disqualified and their record was linked to a death. We used sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) as validity indices.Results　We identified 5,986,991 (1.17%) disqualified and 5,295,961 death cases. Sensitivity, specificity, PPV, and NPV of disqualification for death were 100%, 99.86%, 88.46%, and 100%, respectively. After stratification, PPV of disqualification was between 85% and 88% before 2012, 91% after 2012, 91.9% in men, and 85.9% in women. PPV increased with age (65-69 years: 80.6%, 70-74 years: 86.7%, 75-79 years: 86.4%, 80-84 years: 86.7%, 85-89 years: 88.0%, 90-94 years: 90.6%, and 95+ years: 93.4%) and level of care needed (support level: 72.2%, care level (CL) 1: 79.7%, CL2: 85.9%, CL3: 89.3%, CL4: 92.3%, and CL5: 94.0%).Conclusions　Disqualification from the LTCI registry is an inappropriate measure to estimate mortality accurately because it has a 10% false-positive rate. However, it appears sufficiently valid to use disqualification as a proxy outcome of death, although the main effect or confounding of a possible predictor of death could be slightly underestimated.

Prevention services via public long-term care insurance can be effective among a specific group of older adults in Japan.

BACKGROUND: To evaluate the effects of prevention services provided by long-term care insurance (LTCI) for older adults who require support from LTCI in Kashiwa City, Japan. METHODS: We conducted an analysis using the following population-based longitudinal data in Kashiwa City between April 2012 and March 2015: Data of National Health Insurance and LTCI claims, the survey for certification of LTCI, the register, and premium tier classification. All data was linked using the pre-assigned anonymous identifying numbers. We analyzed the Cox regression model using the time for the deteriorations of levels of certified care need in LTCI as an outcome and the use of preventive care services as the primary exposure among participants aged 75 years or older, who had either support levels 1 or 2 at the beginning of this analysis. The study was further stratified by both age and initial support level. RESULTS: The final analysis included 1289 participants. The primary result showed, among all participants, that preventive service was not effective (hazard ratio 0.96, 95% confidence interval 0.78-1.19). In our sub-analysis, the preventive service was effective in avoiding deteriorations only among those aged 85 and older with support level 1 (HR 0.65, 95% CI 0.43-0.97) out of four groups. CONCLUSIONS: The preventive services of LTCI in Kashiwa City showed a significant effect on the deterioration among subjects aged 85 or older, whose disability level were low (support level 1). Our results suggest that the prevention services provided by LTCI may not be effective for all older individuals; to provide these services efficiently, local governments, as insurers of LTCI, will need to identify the specified groups that may benefit from the preventive services. Additionally, it is necessary to re-examine what preventive interventions may be effective, or redesign the health system if necessary, for those who were not affected by the intervention.

Change of Use in Community Services among Disabled Older Adults during COVID-19 in Japan.

During the COVID-19 pandemic, social interactions were restricted, including community services for disabled older adults. This study aimed to describe the change of use in community services related to long-term care insurance (LTCI) during the pandemic in Japan. A retrospective descriptive study was conducted using data collected via a cloud-based management support platform for older adult care provider "Kaipoke", by a private-sector company "SMS Co., Ltd.", in which care-managers of LTCI manage their office work. Data collection occurred from July 2019 to June 2020. Study subjects were LTCI service users aged 65 years and above. Subjects were living at home. We examined changes in the number of users of LTCI services before and after the COVID-19 pandemic began, using an interrupted time-series analysis. Results indicated that the use of outpatient services was reduced; however, home-visit services were maintained. The decrease in use was significant in the seven prefectures where the infection initially spread. There are concerns that older adults or surrounding caregivers can be affected by such changes in LTC service use. It is therefore necessary to implement sustainable measures from a long-term perspective and investigate their influence as part of future studies.

Comparison of progression of care-need levels among long-term care recipients with and without advanced care management in a rural municipality of Japan: A population-based observational study.

BACKGROUND: Little is known about the association between advanced care management and patient outcomes in home settings. In 2009, the Japanese government introduced a financial incentive scheme for advanced care management by long-term care agencies with at least one advanced care manager. However, it remains unclear whether advanced care management in rural areas is associated with improved outcomes for recipients. OBJECTIVE: To compare the progression of care-need levels among long-term care recipients in home settings with and without advanced care management. DESIGN: A population-based observational study. SETTING: A rural municipality in Japan. PARTICIPANTS: Recipients of long-term care (n = 2005). METHODS: We used individual-level secondary data provided from a rural municipal government that was collected as part of the Survey of Long-Term Care Benefit Expenditures and medical care claim records between April 2012 and March 2017. We linked these two databases using unique identifiers. The inclusion criteria for study subjects were that they: (1) were aged ≥65 years; (2) were newly certified as care-need level 1, 2, or 3; and (3) used long-term care insurance services in home settings from April 2012 through March 2017. We excluded individuals using long-term care insurance services for less than six months. Ultimately, we selected 1722 propensity-matched recipients with and without advanced care management, and then conducted Kaplan-Meier survival analyses and a log-rank test. The outcome measure was progression of care-need levels. RESULTS: The proportions of five-year cumulative progression-free survival in the groups with and without advanced care management were 50.3% and 42.2% for recipients of care-need level 1 (p < .01), 34.3% and 32.3% for recipients of care-need level 2 (p < .01), and 22.3% and 24.5% for recipients of care-need level 3 (p > .05), respectively. The progression-free period lasted a median of 12 (interquartile range, 10-24) months for recipients of care-need level 1, 14 (interquartile range, 11-28) months for recipients of care-need level 2, and 12 (interquartile range, 10-24) months for recipients of care-need level 3. CONCLUSIONS: Long-term care recipients with advanced care management in home settings had a higher probability of progression of care-need levels in a rural municipality of Japan. This finding suggests that the governmental policy of providing financial incentive for advanced care management may not be effective in improving the outcome of long-term care recipients in a rural municipality of Japan.

Health Promotion Awareness in Barbershops and Salons: An International Cross-Sectional Survey in Japan and Thailand.

Aging societies are a worldwide concern, as people are living longer than ever before. The success of the "barbershop project" in improving community health in the USA suggests that the aging issue can be tackled using this method even in Asia. Nevertheless, the health promotion awareness of barbers/stylists has barely been reported in Asia. This study aimed to identify the health promotion awareness of barbers and stylists in Japan and Thailand. An international cross-sectional survey was conducted between March and December 2017. Questionnaire contents included the "current status of existing health-promotion-related services," "awareness of contribution to maintaining people's health," and "awareness of collaboration with health care professionals." Participants were 99 Japanese and 101 Thai shop owners. In Japan, more health-promotion-related services were already provided through shops, and health care awareness was higher than in Thailand. In both countries, some shops were willing to collaborate with health care professionals. In Japan, "barbers/stylists have consultation opportunities with health care professionals," "health-related leaflets are provided," "development of therapy/care," and "barbershops/salons become a bridge between communities and hospitals" were mentioned as ideas for collaboration. In conclusion, barbers/stylists are highly interested in health due to the direct connection between beauty and health. Collaboration between barbershops/salons and health care professionals is possible, especially in Japan due to its super-aging society. Further development of the barbershop/salon project is needed.

[Estimation of duration of formal long-term care among frail elderly people in Japanese communities using national long-term care insurance claims records].

Objective　The aim of this nationwide study was to estimate the duration of formal long-term care, provided by Japanese long-term care insurance (LTCI) services, among frail Japanese elderly people living in the community.Methods　The study subjects were 2,188,397 (men: 579,422, women: 1,124,022, age≥65 years) beneficiaries who used LTCI services for community living in June 2013. The duration of LTCI services for community living per diem per capita was estimated by converting the benefit amount to duration of care using the code for service in claims bills according to gender and care levels, which are a nationally certified classification of individual needs for long-term care (care level 1: lowest need, care level 5: highest need). Subsequently, LTCI services for community living were categorized into respite services and community services. Community services were further subcategorized into home visiting services and daycare services.Results　The overall average duration of formal care per diem per capita for men and women were 97.4 and 112.7 minutes for care level 1, 118.3 and 149.1 for care level 2, 186.9 and 246.4 for care level 3, 215.2 and 273.2 for care level 4, and 213.1 and 261.4 for care level 5, respectively. Length of respite services increased gradually with care level, whereas duration of community services peaked at care level 3 and decreased at care levels 4 and 5. With regard to the community service subcategories, duration of home visiting services increased with care level, but duration of daycare services peaked at care level 3.Conclusion　Although the care levels in the LCTI system are designed to assess the need for formal care in terms of duration of care, our results suggest that the use of formal LTCI services for community living is not vertically equitable. Services that efficiently increase duration of formal care for those with higher needs for care may improve the equity and sustainability of formal long-term care services for community living.

Disability, poverty, and role of the basic livelihood security system on health services utilization among the elderly in South Korea.

With rapid aging, many of the elderly suffer from poverty and high healthcare needs. In Korea, there is a means-tested and non-contributory public assistance, the National Basic Livelihood Security System (NBLSS). The purpose of this study is to show older population's condition of disability and poverty, to evaluate the impact of NBLSS on health services utilization, and to examine the differential effect of the NBLSS by disability status among the elderly. This study used the Korea Welfare Panel Study data 2005-2014 with the final sample of 40,365, who were 65 years and older. The participants were divided into people with mild disability, severe disability, and without disability according to the Korean disability registration system. The income-level was defined to the low-income with NBLSS, the low-income without NBLSS, and the middle and high income, using the relative poverty line as a proxy of the low-income. The dependent variables were the number of outpatient visits and inpatient days, experience of home care services, total healthcare expenditure, and financial burden of healthcare expenditure. We performed Generalized Estimating Equations population-averaged model using the ten years of panel data. The result showed that within the same disability status, the low-income without NBLSS group used the least amount of inpatient care, but their financial burden of health expenditure was the highest among the three income groups. The regression model showed that if the elderly with severe disability were in the low-income without NBLSS, they reduced the outpatient and inpatient days; but their financial burden of healthcare became intensified. This study shows that the low-income elderly with disability but without adequate social protection are the most disadvantaged group. Policy is called for to mitigate the difficulties of this vulnerable population.

Dietary patterns and nutritional assessment in middle-aged and elderly men.

Objectives Dietary patterns are studied to determine the relationship between diet and health. However, little is known about whether various dietary patterns fulfill adequate nutrient intake. Therefore, the purpose of this study was to investigate the association between major dietary patterns and nutritional intakes in middle-aged and elderly men. Furthermore, we examined the associations between dietary patterns and micronutrients status by using the reference values from the Dietary Reference Intakes for Japanese 2010 (DRIs-J 2010).Methods A total of 229 middle-aged and elderly men (age range, 40-79 years) participated in this study. The dietary patterns were determined using principal component analysis of 52 food and beverage items via a validated brief diet history questionnaire. Overall, micronutrient intake status was quantified using a dietary reference intakes score (DRIs-score) for 21 micronutrients (based on the DRIs-J 2010). The association of the nutrient intake and the DRIs-score with each factor score was evaluated using Spearman's correlation coefficient.Results Three dietary patterns were identified: "side dish", "evening drink", and "snack". The "side dish" pattern was characterized by a high intake of vegetables, fruits, seaweeds, mushrooms, and potatoes, and low intake of rice. Spearman's correlation showed that the "side dish" pattern correlated with each of the 21 micronutrients, and positively correlated with the DRIs-score (ρ=0.782, P<0.001).Conclusions The "side dish" pattern was positively related with the DRIs-score, calculated from the DRIs-J 2010. The result suggested the "side dish" pattern may provide a favorable nutrient balance in middle-aged and elderly men.

Loosening of DNA/polycation complexes by synthetic polyampholyte to improve the transcription efficiency: effect of charge balance in the polyampholyte.

High mobililty group proteins are amphoteric nuclear proteins that are known to unfold chromatin to stimulate transcription. To mimic their structures, we synthesized the novel polyethylene glycol (PEG) derivatives, PEG-ACs, consisting of both amino- and carboxyl-pendants in various ratios, and their loosening and transcription-improving activity on the DNA complex was examined. Fluorescence anisotropy measurement revealed that anionic PEG-ACs with more carboxyls than amines could efficiently loosen the DNA/polyethyleneimine complex. Those anionic PEG-ACs showing a loosening effect on the DNA complex evidently increased the transcription rate to >20 times higher than that of the original complex, probably owing to the facilitated approach of transcriptional factors to the DNA segments in the loosened complexes. The complexes with anionic PEG-ACs also showed improved transgene expression level on the cultured cells, indicating the effectiveness of improving transcriptional activity to attain a high extragene expression by the plasmid complex. The loosening mechanism of DNA/polycation complexes was investigated with a simplified model via Monte Carlo simulation to discern the difference in the presence of cationic polyampholytes, anionic polyampholytes, and polyanions.

Palliative care needs of cancer outpatients receiving chemotherapy: an audit of a clinical screening project.

PURPOSE: Although more and more cancer patients are receiving chemotherapy in outpatient settings in their advanced stage and could have a broad range of palliative care needs, referral to the specialized palliative care service is often delayed. The primary aim of this study is to explore the usefulness of a combined intervention for cancer patients in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service. The intervention consisted of (1) introducing the specialized palliative care service when starting chemotherapy, (2) using screening tools, and (3) providing on-demand specialized palliative care service. MATERIALS AND METHODS: All cancer patients newly starting chemotherapy with primary tumor sites of the lung, gastrointestine, pancreas, bile duct, breast, ovary, and uterus were included. As routine practice, at the first instruction about chemotherapy, pharmacists provided information about the role of the specialized palliative care service using a pamphlet and handed out screening questionnaires. Screening questionnaires were distributed at every hospital visit. Treating physicians and/or nurses checked the questionnaire before examining the patients. The patients were referred to the palliative care team, if (1) the patients voluntarily wished for the specialized palliative care service or (2) the treating physicians clinically determined that, on the basis of the screening results, the patients had physical or psychological needs appropriate for referral to the specialized palliative care service. The screening questionnaire included an open-ended question about their greatest concerns, the severity of 11 physical symptoms, overall quality-of-life, the distress thermometer, help for information about the treatment and decision-making, economic problems, nutrition, daily activities, and wish for help from the specialized palliative care service. RESULTS: Of 211 patients who newly started chemotherapy, 5 patients refused to complete the questionnaire (compliance rate, 98%). We obtained 1,000 questionnaires from 206 patients. The percentages of missing values ranged from 2.7% to 7.0%. Of 206 patients, 38 (18%) were referred to the palliative care team due to newly recognized problems, in addition to 10 patients with problems well-recognized by primary physicians. The total percentage of patients receiving specialized palliative care service was thus 23% of all patients. Frequently identified problems were oral problems (20%), insomnia (20%), help with information and decision-making (16%), psychological distress defined as the distress thermometer (14%), severe fatigue (9.0%), and severe appetite loss (8.8%). As a whole, problems were identified in half of all questionnaires. CONCLUSION: The combined intervention of introducing the specialized palliative care service, using screening tools and providing on-demand specialized palliative care service, was feasible as part of the routine clinical practice for all cancer patients starting chemotherapy. It might be useful in identifying patients with under-recognized palliative care needs and referring them to the specialized palliative care service at the appropriate time.