Effect of short-stay service use on stay-at-home duration for elderly with certified care needs: Analysis of long-term care insurance claims data in Japan.

OBJECTIVE: Home independence is an important issue for the elderly in many countries and cultures. The aim of this study was to examine the effect of short-stay service use on stay-at-home duration for elderly people by level of care need under the Japanese long-term care insurance system. METHODS: We analyzed anonymous, Ministry of Health, Labour and Welfare of Japan Long-Term Care Insurance claims data from Ibaraki Prefecture. All participants were certified as eligible for long-term care insurance and had moved into a facility under long-term care insurance after certification between April 2006 and March 2012. Data was analyzed for 2,454 participants aged 65 years or older who entered residential care at least 1 month after initial use of care services. The participants were divided into 2 groups (low- and high-care need), depending on their required level of care. Cox proportional hazard modeling was used to calculate the adjusted hazard ratio (HR) of residential care admission after initial use of care services. RESULTS: Use of short-stay services was positively correlated to delay of residential care admission compared to non-use in the low-care need group (HR; 0.834, 95% confidence interval (CI); 0.740-0.939). In the high-care need group, however, use of short-stay services was somewhat correlated with earlier admission (HR; 1.254, 95% CI; 1.084-1.451). CONCLUSIONS: The results of this study show that appropriate timing short-stay service use is necessary for the elderly to stay at home longer.

Association of care recipients' care-need level with family caregiver participation in health check-ups in Japan.

AIM: The public mandatory long-term care insurance system in Japan has supposedly mitigated the care burden for family caregivers of older adults, whereas family caregivers still play a considerable role in providing care. The effect of informal caregiving on the caregiver's health has been of great interest. We investigated the relationship between the amplitude of informal caregiving and caregiver participation in health check-ups in Japan. METHODS: The present study was a cross-sectional analysis of nationally representative data in Japan (2010 Comprehensive Survey of Living Conditions). We investigated the relationship between care recipients' care-need level and in-home caregiver participation in health check-ups during the last year of the survey for caregivers. RESULTS: A total of 3354 caregiver/recipient pairs were included in the study. Crude proportions of caregivers completing a health check-up by care-need level were 68.4% (support required 1 and 2), 63.5% (care required 1-3) and 60.3% (care required 4 and 5). Higher care-need level was negatively associated with caregiver participation in health check-ups (support required 1 and 2as reference, care required 1-3: odds ratio 0.82, 95% confidence interval 0.75-0.90), care required 4 and 5: odds ratio 0.76, 95% confidence interval 0.74-0.79) after adjustment for possible confounders. Inclusion of the caregiver time devoted to care per day and caregiver self-rating of health as independent variables did not change the result. CONCLUSIONS: These results suggest that facilitating health check-up participation for family caregivers of care recipients with higher care-need levels might be an effective intervention for decreasing the gap in health behavior possibly caused by informal caregiving. Geriatr Gerontol Int 2018; 18: 26-32.

Mental Health of Parents as Caregivers of Children with Disabilities: Based on Japanese Nationwide Survey.

The number of children with disability is increasing gradually in Japan. Previous researches in other countries have reported that parents as caregivers (CGs) of children with disability have mental health problems, but the actual situation has not been examined nationwide in Japan so far. The aim of this study was to evaluate the association between mental health of CGs who had children with disability and characteristics of children, CGs, and household based on the nation-wide survey. This study utilized data from 2010 Comprehensive Survey of the Living Conditions, and defined children with disability aged 6 to 17. Individual data of children and CGs were linked, and 549 pairs of them were extracted. The Japanese version of Kessler 6 (K6) was used to assess mental health status of caregiver, scored 5 and over represented to general psychological distress. Logistic regression was used to evaluate the associations of interest. The almost half (44.4%) of CGs had psychological distress (k6 score; 5 +) in nationwide, and 8.9% of CGs might have serious mental illness (K6 score; 13 +). After adjusting covariates of child, CG, and household factors, CG having a current symptom (OR, 95% CI: 3.26, 1.97-5.39), CG's activity restriction (OR, 95% CI: 2.95, 1.38-6.32), low social support (OR, 95%CI: 9.31, 1.85-46.8), three generation family (OR, 95% CI: 0.49, 0.26-0.92), and lower 25% tile group of monthly household expenditure (OR, 95% CI:1.92, 1.05-3.54), were significantly associated with psychological distress of CGs. This study encourages health care providers to pay more attentions toward parent's mental health, especially for in case of having low social support, and lower income family. Further research should examine the detailed information of child's disease and disability, medical service use, and quality and quantity of social support in nationwide to straighten the system for supporting services of both children with disabilities and their CGs.

[Introduction of long-term care insurance: changes in service usage].

OBJECTIVES: With the aging of the population, Japan's long-term care system has shifted from a welfare-placement system to a social-insurance system, which is a precedent of policies for the elderly. We examined how individuals who used care services before the implementation of long-term care insurance (LTCI) (previous service users) currently use the LTCI services, with a focus on the processes of service use. METHODS: Panel data were obtained from the Nihon University Japanese Longitudinal Study of Aging database. These data were collected by interviews conducted before (November 1999 and March 2000) and after (November 2001 and December 2001) the establishment of LTCI. Among the 3992 individuals who participated in these interviews, 416 of the previous service users, aged ≥65 years, were sampled. The outcome measures were the processes of using LTCI services (application for LTCI, certification of long-term care need, and contract with LTCI service providers). Logistic regression analysis was performed to identify individual factors associated with the process of application for LTCI. RESULTS: There were 133 LTCI users among the 416 previous service users (32.0%). Of the service processes used, 45.5% of previous service users were applicants, 85.7% of the applicants were certified individuals, and 88.7% of those certified used services with service contracts. The application process was significantly easier for individuals with disease (odds ratio[OR], 8.34 : 95% confidence interval [CI], 1.86-37.46), those dependent for their instrumental activities of daily living (IADL) (OR, 11.21 : 95% CI, 5.22-24.07), those with an equivalent income of <1.25 million yen (OR, 2.72 : 95% CI, 1.30-5.69), and those who had used respite care (OR, 3.29 : 95% CI, 1.16-9.35) previously. In contrast, the application process was significantly difficult for community rehabilitation users (OR, 0.38 : 95% CI, 0.17-0.82). CONCLUSION: Only half of the previous service users were applicants, and they had severe diseases or were more dependent for their IADL. Our findings suggest that many individuals who were functionally independent were covered under the welfare-placement system. Additionally, low-income individuals did not refrain from applying.