[Possibilities for detection of homebound elderly people through the welfare commissioner (Minsei-iin)].

OBJECTIVES: The purposes of this study were (1) to evaluate the percentage of homebound elderly people that could actually be detected through commissioners who consciously tried to detect and provide information regarding these people, and (2) to identify difficulties that commissioners experienced when attempting to detect and provide information about such people. METHODS: This study was conducted in one of the districts of a city in Kanto area. The percentage of detection of homebound elderly people was calculated by following the 3 steps described below. First, the number of homebound elderly people was estimated by using the probability sample survey on elderly people living in the district. Second, detection and information activities were conducted by the commissioner in the district over a 2-month period. Finally, the detection rate through the commissioner's efforts was calculated. The detection rate was calculated by dividing the number of homebound elderly people detected through commissioners by the estimated number of homebound elderly people in the district. The difficulties that commissioners experienced were analyzed by using the KJ method to analyze qualitative data obtained from focus group interview surveys for commissioners. RESULTS: The commissioners actually detected and reported 1.4% of homebound elderly people. The difficulties in detection and reporting included the lack of opportunities for detection and hesitation in providing information about homebound elderly people. CONCLUSION: Although the commissioners are not completely responsible for detection of homebound elderly people, the rate of detection through these commissioners can be higher. To improve this rate of detection, the commissioner's other responsibilities need to be limited and the anonymity of the commissioners who provided information regarding homebound elderly people should be restricted to avoid harming their relationships with the elderly.

[Factors related to under-utilization of in-home services under the long-term insurance system].

PURPOSES: This study was conducted to examine factors associated with under-utilization of in-home services covered by the long-term care insurance. Under-utilization was measured in terms of the discrepancy rate between benefits limits and service costs for individuals. Based on the behavioral model, possible predictors were chosen; the level of nursing care as the need factor, living arrangements and income as enabling factors, and family caregiving consciousness as a predisposing factor. Both direct and interaction effects of those factors were examined. METHODS: 1,500 people were randomly selected from all people certified as needing long-term care in one ward, Tokyo to be interviewed. People categorized as "requires assistance" or "requires nursing care level 1" were interviewed directly. With people categorized as "level 2" to "level 5", their primary caregivers were interviewed. Information about in-home service utilization was collected from the insurer. RESULTS: People who were categorized as requiring a lower level of nursing care, lived with others, had a low income, or had high family caregiving consciousness demonstrated significantly greater under-utilization rate as compared with others. An interaction between living arrangements and the level of nursing was observed in this regard. While people who lived alone exhibited low a level of under-utilization rate without regard of the level of nursing care, the rate changed by those who lived with other. CONCLUSIONS: Under the new system, informal support might have a significant impact on under-utilization of in-home services. The responsibility for paying 10% of total care costs might be related to under-utilization by people with low income, though reduction of individual co-payments has been introduced for individuals in difficult financial conditions.