Impact of home and community-based services on hospitalisation and institutionalization among individuals eligible for long-term care insurance in Japan

Study Aim/Purpose: This study examined the effect of use of home and community-based services for the elderly on their admission to a hospital or residential care facility. 

Summary of Methods: This study used a retrospective cohort design and analyzed linked health insurance and long-term care insurance (LTCI) claims data for 565 adults from two farming communities in Hokkaido, Japan. The key outcomes measured after initial date of LTCI certification were time to hospitalization (above a minimum threshold expenditure to exclude short episodes of hospitalization) and time to admission to a group home for the elderly with dementia or other residential care facility for the elderly. The effect of home and community-based services use on these outcomes was analyzed looking at this dependent variable in three ways: (1) average monthly total home and community-based services expenditures; (2) the use or non-use of each of the following types of home and community-based services: home-help, visiting nurse, management and guidance, day care, day rehabilitation, respite care and rental services for assistive devices; and (3) average monthly expenditures for home-visit and day care types of services, use or non-use of respite care, and use or non-use of rental services for assistive devices. Recognizing that the presence of a disease and its severity at the time of the individual’s first certification for LTC could be confounding factors, the authors adjusted the analysis for outpatient medical expenditures as a proxy for the severity of illness. 

Summary of Results: The authors found that the elderly with low, medium or high expenditures for home and community-based services were less likely to be hospitalized or institutionalized than the non-users of home and community-based services. Among the types of home and community-based services, the strongest association with reduced hospitalization and institutionalization was found among users of respite care and users of rental services for assistive devices. 

Study Limitations (as cited by authors): The authors note that the results were biased due to residual and unmeasured confounding factors, including factors for which the data were not available, such as the presence or absence of family members living with the individual who may provide support. They also indicated that because the study was conducted only in farming communities and thus not generalizable to urban areas or other regions of the country. 

Authors’ Discussion/Conclusions: In explaining their results, the authors suggest that home and community-based services, particularly respite care, reduce the care burden of caregivers, thus allowing caregivers to maintain their ability to provide care.