Use of home health services covered by new public long-term care insurance in Japan: impact of the presence and kinship of family caregivers

Tamiya, Nanako; Yamaoka, Kazue; Yano, Eiji

doi:10.1093/intqhc/14.4.295

Cited by 35 publications

(28 citation statements)

References 20 publications

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“…Among these, the indirect costs related to the family caregivers are extremely relevant [24] and may even further affect the effectiveness of any domiciliary program, especially in those individuals who are totally home bound or confined to bed. Indeed, it has been calculated that the use of major services and resources may be decided more by the needs of caregivers than by the care level of the applicant [29]. Additionally, the estimation of the costs for initiating domiciliary ventilation is missing; indeed, it could also be important to calculate how many patients have to try the equipment before the staff finds the patient who really accepts the treatment.…”

Section: Discussionmentioning

confidence: 99%

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Clini

Magni²,

Crisafulli³

et al. 2008

Respiration

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Background: A cost analysis of nocturnal non-invasive ventilation (NNV) in stable chronic obstructive pulmonary disease (COPD) patients would be helpful in decision making, when the balance between the increased demand and the availability of resources should be checked. Objectives: Based on data from the Italian trial in stable hypercapnic COPD patients, this study compares the cost of care associated with the use of NNV when added to the usual long-term oxygen therapy (LTOT) with the cost of care of LTOT regimen alone. Methods: Cost was calculated in 77 of 90 patients included into that trial. Analysis included drug therapy, hospitalisations due to acute exacerbation, oxygen and ventilator equipments. An estimation of charges was made according to the national sources of cost for drugs and hospital admissions and the actualised reimbursement for the home care provided to both oxygen and ventilator users. The cost/day comparison was made between the individual patients in the 2 groups (NNV + LTOT, n = 35; LTOT, n = 42). Results: The mean cost of drugs and oxygen was similar in both groups, whereas the cost of hospitalisation tended to be lower in NNV + LTOT compared to LTOT alone (8.25 ±10.29 vs. 12.50 ± 20.28 EUR/patient/day, p < 0.05). Inclusion of the ventilator equipment increased the total cost to 23.73 EUR/day in the NNV + LTOT compared to 21.42 EUR/day in the LTOT group (not significant). Conclusions: The present report suggests that long-term management with addition of non-invasive ventilation does not increase costs compared with the usual LTOT regimen: the hospital-related costs were reduced when using the ventilator in these hypercapnic COPD patients.

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Section: Discussionmentioning

confidence: 99%

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Clini

Magni²,

Crisafulli³

et al. 2008

Respiration

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“…A study conducted in Japan described the use of welfare and healthcare services by older community-dwellers who had applied for long-term care insurance, most of whom required personal assistance in daily activities. Of 237 participants with care-givers, only 22% did not use any kind of service, and more than one-third used two or more services (9). In Europe, the proportion of older disabled persons who received home-care services ranged from 24% in Denmark to less than 4% in Italy, Spain and Portugal (2,10).…”

Section: Discussionmentioning

confidence: 99%

Care available to severely disabled older persons living at home in Florence, Italy

et al. 2008

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Aims-To characterize the epidemiology of disability in, and the level of care available to, older community-dwellers in an Italian urban sample.Methods-In a 2-phase survey, persons aged 65+ years, randomly selected from the patients lists of 98 primary care physicians (PCP), were screened (phase I) by their PCP with a structured questionnaire to detect the presence of: 1) need of help in performing Basic and 2) Instrumental Activities of Daily Living (BADL, IADL); 3) poor vision or 4) hearing; 5) weight loss; 6) use of homecare services; 7) self-perceived inadequacy of income. Subjects reporting 2+ problems were further evaluated in face-to-face structured interviews (phase II).Results-Of 5445 participants, 597 (11%) screened positive in phase I and 416 were interviewed in phase II. Of these, 4, 29, 19 and 49% were disabled in 1-2 IADL, 3+ IADL, 1-2 BADL, and 3+ BADL. The extent of the support network increased with disability severity (p<0.01). The 274 participants with BADL disability received most of their help from close relatives (58.3±2.5%), followed by salaried assistants (20.5±2.1%), other relatives (19.5±1.9%), and public healthcare services (0.6±0.36%). Of the 397 care-givers interviewed, one-third were willing to institutionalize the older participants in case of further functional deterioration. This propensity was predicted only by a self-reported poor attitude towards caring.Conclusion-Many severely disabled older Italians receive care in their home by highly supportive family members. The level of assistance provided to them by public healthcare services is minimal.

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“…The recent introduction of public long-term care insurance in April 2000 and changes in legislation provide disincentives for longer hospitalization and encourage the frail elderly to be discharged earlier. Tamiya et al (2002) reported that the use of home services covered by long-term care insurance was determined by the needs of caregivers rather than by the care needs of the applicant. More home services were used in the case of a wife caring for her husband.…”

Section: Discussionmentioning

confidence: 99%

Gender and Family Composition Related to Discharge Destination and Length of Hospital Stay after Acute Stroke

Ohwaki

Hashimoto

Tokuda

et al. 2005

Tohoku J. Exp. Med.

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Informal care by family members still plays an important role in home care after acute stroke. This study determined the clinical and demographic factors, such as family structure, that predict discharge to home and length of hospital stay (LOS) after acute stroke hospitalization. We reviewed the sex, age, family structure before stroke, type of stroke, size of the lesion, activities of daily living (ADL) function at discharge, discharge destination, and LOS of stroke patients (114 cerebral infarctions and 44 intracerebral hemorrhages) admitted to a neurosurgical hospital. Patients with cerebral infarction were older than those with intracerebral hemorrhage (median 75 vs 66 years). Ninety-eight were discharged to home (62%). In the logistic regression analysis, low ADL function, medium or large infarction, and intracerebral hemorrhage (vs lacunar infarction) were significantly associated with discharge to a destination other than home. Of the patients discharged home, low ADL function was strongly associated with LOS in the multiple regression analysis. In addition, living with a spouse only had the opposite effect on LOS in men and women ( p = 0.050 and 0.071, respectively). LOS tended to be shorter for men with a wife, but longer for women with a husband. The structure and gender roles in a stroke patient's household may need further attention for the efficient use of hospital resources.gender; family; stroke outcome; hospitalization © 2005 Tohoku University Medical PressStroke remains the third highest cause of mortality in Japan, resulting in 130,000 deaths per year (Ministry of Health, Labour and Welfare 2004). Although the fatality rate has decreased in the last few decades, a large number of acute survivors still suffer functional disabilities that lead to institutionalization and a consequent economic burden on the patient's household and society as a whole. With the rapid increase in the population of elderly, it is even more important to identify stroke patients who are at risk of a prolonged hospital stay in order to enhance their return home.

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Use of home health services covered by new public long-term care insurance in Japan: impact of the presence and kinship of family caregivers

Abstract: The use of major services may be decided more by the needs of caregivers than by the care level of the applicant. To successfully implement the new system, consideration of the caregiver situation should be included in policy making.

Cited by 35 publications

References 20 publications

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Home Non-Invasive Mechanical Ventilation and Long-Term Oxygen Therapy in Stable Hypercapnic Chronic Obstructive Pulmonary Disease Patients: Comparison of Costs

Care available to severely disabled older persons living at home in Florence, Italy

Gender and Family Composition Related to Discharge Destination and Length of Hospital Stay after Acute Stroke

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