Clarifying Problems with Emergency Healthcare Systems in Japanese Long-Term Care Facilities for Older People

Abstract

Background: Long-term care facilities for older people play an important role as alternatives to family care in an aging society. This study aimed to assess staffing problems linked to emergency healthcare for residents of these facilities, and to investigate the relationship between these problems and the characteristics of the facilities. Methods: The study surveyed managers of long-term care facilities for older people in a Japanese urban area between September and December 2014. The type of care facility, the number of staff and any problems providing or accessing emergency healthcare for the residents were evaluated. Multiple logistic regression analysis was used to explore the factors common to facilities reporting staffing problems linked to emergency healthcare of residents. Results: In total, 321 long-term care facilities were eligible for this study and 226 (70%) returned the questionnaire. We compared the characteristics of facilities reporting and not reporting staffing problems in emergency healthcare of residents. The type of care facility was significantly associated with staffing problems in emergency healthcare of residents both during the day (p < 0.01) and at night (p = 0.04). The facilities most likely to report problems were group homes for older people with dementia, because of staffing shortages. Conclusions: Problems in emergency healthcare systems in Japanese long-term care facilities for older people varied by type of care facility. Our data underscore the need for telemedicine and consideration of mergers between smaller facilities such as group homes for older people with dementia.

Containment of COVID-19 outbreaks with lower incidence and case fatality rates in long-term care facilities by early intervention of emergency response teams

“…Second, residents in LTC homes are relatively healthier than residents in LTC nursing homes and hospitals because only residents who do not require sustained medical intervention can reside in LTC homes. Third, residents in LTC homes are relatively more independent with a lower requirement of care workers leading to lower chances of spread of the disease from care workers to residents [4]. Thus, the management of outbreaks in LTC hospitals and nursing homes faces difficulties because of limited availability of isolated rooms, the requirement of medical interventions to the residents, and the requirement of nursing care with close contact with the residents.…”

“…LTCFs also afford a high possibility of progression to a massive outbreak owing to the congregate living environments. The capacities of LTCFs for emergency management are limited [4]. In addition, the shortage of care workers at LTCFs has been a common concern in most facilities, even before the COVID-19 outbreak [5][6][7].…”

Factors related to liability for damages for adverse events occurring in long-term care facilities

“…LTCFs that provide services under the banner of safety and security may face increasing levels of liability and lawsuits in the future. There have been 85 nursing care accident-related court cases in Japan (between 2011 and early January 2016) in which falls, aspiration, wandering, and bedsores have resulted in lawsuits [30].…”

“…The causes of liability for damages are associated with residents' conditions, the quality of care in LTCFs, and staffing. Most of the AEs resulting in liability for damages occur within facilities in cases where the facility structures are inadequate, such as when a care worker delays calling the resident for emergency transport or where safety measures were not implemented when a resident chose to spend time alone [30,31]. For example, in a death by choking case in a fee-based home for older adults, Resident A was served a bread roll in a private room.…”