Abstract
In Japan, an “Integrated Community Care” model has been introduced into the public long-term care insurance (LTCI) system to help persons ageing in place. The aim of the present study was to examine the association between the development of an Integrated Community Care system and the number of nursing home placements under the LTCI program among municipal governments in Japan. Development of the Integrated Community Care system was assessed by a paper questionnaire distributed to each municipality. The annual number of elderly nursing home placements was obtained from published national statistics data over a 10-year period from 2001 to 2010. The sample consisted of 612 municipalities (35.1 % of all municipalities) that responded to the questionnaire. A multilevel linear regression analysis for panel data revealed significantly smaller annual numbers of nursing home placements per 1000 elderly persons among municipalities that had larger number of agencies joining in multiple service networks of the Integrated Community Care system. A significantly greater number of nursing home placements was also observed among municipalities that had a larger elderly population rate, lower annual number of elderly individuals in intermediate care per 1000 elderly persons, and smaller number of elderly individuals in congregate housings per 1000 elderly persons. The national “ageing in place” policy should explore a revised model of the Integrated Community Care system that is applicable for areas with limited resources.
Similar content being viewed by others
References
Anderson, J. K., Bonner, A., & Grootjans, J. (2011). Collaboration: developing integration in multi-purpose services in rural New South Wales, Australia. Rural and Remote Health, 11(4), 1827.
Braithwaite, J. (2001). Regulating nursing homes: the challenge of regulating care for older people in Australia. British Medical Journal, 323(7310), 443–446.
Breton, M., Denis, J. L., & Lamothe, L. (2010). Incorporating public health more closely into local governance of health care delivery: lessons from the Québec experience. Canadian Journal of Public Health, 101(4), 314–317.
Campbell, J. C., & Ikegami, N. (2000). Long-term care insurance comes to Japan. Health Affairs, 19(3), 26–39.
Dunér, A., Blomberg, S., & Hasson, H. (2011). Implementing a continuum of care model for older people-results from a Swedish case study. International Journal of Integrated Care, 11, e136.
Forder, J. (2009). Long-term care and hospital utilisation by older people: an analysis of substitution rates. Health Economics, 18(11), 1322–1328.
Harrington, C. A., Geraedts, M., & Heller, G. V. (2002). Germany’s long-term care insurance model: lessons for the United States. Journal of Public Health Policy, 23(1), 44–65.
Huss, A., Stuck, A. E., Rubenstein, L. Z., Egger, M., & Clough-Gorr, K. M. (2008). Multidimensional preventive home visit programs for community-dwelling older adults: a systematic review and meta-analysis of randomized controlled trials. The Journals of Gerontology Series A, Biological Sciences and Medicine Sciences, 63(3), 298–307.
Ikegami, N. (2007). Rationale, design and sustainability of long-term care insurance in Japan-in retrospect. Social Policy and Society, 6(3), 423–434.
Kuzuya, M., Hasegawa, J., Hirakawa, Y., Enoki, H., Izawa, S., Hirose, T., & Iguchi, A. (2011). Impact of informal care levels on discontinuation of living at home in community-dwelling dependent elderly using various community-based services. Archives of Gerontology and Geriatrics, 52(2), 127–132.
Lehning, A. J. (2012). City governments and aging in place: community design, transportation and housing innovation adoption. The Gerontologist, 52(3), 345–356.
Manthorpe, J., Clough, R., Cornes, M., Bright, L., Moriarty, J., Iliffe, S., & OPRSI (Older People Researching Social Issues). (2007). Four years: the impact of the National Service Framework for Older People on the experiences, expectations and views of older people. Age and Ageing, 36(5), 501–507.
Ministry of Health, Labour and Welfare. (2011). Act for Partial Revision of the Long-Term Care Insurance Act, Etc., in Order to Strengthen Long-Term Care Service Infrastructure. http://www.mhlw.go.jp/english/policy/care-welfare/care-welfare-elderly/dl/en_tp01.pdf. Accessed 10 Dec 2012.
Ministry of Health, Labour and Welfare. (2012). Kaigo Hoken Tokubetsu Kaikei, 2010 [Financial Report on Long-Term Care Insurance, 2010]. http://www.e-stat.go.jp/SG1/estat/NewList.do?tid=000001031648. Accessed 10 Dec 2012.
Ministry of Internal Affairs and Communications. (2012). 2010 Population Census. Tokyo, Japan: Japan Statistical Association (in Japanese).
Montgomery, L., & Campbell, A. (2012). A qualitative evaluation of the provision of bereavement care accessed by service users living in a Health and Social Care Trust area in Northern Ireland. Journal of Social Work in End-of-Life & Palliative Care, 8(2), 165–181.
Mur-Veeman, I., van Raak, A., & Paulus, A. (2008). Comparing integrated care policy in Europe: does policy matter? Health Policy, 85(2), 172–183.
Nakanishi, M., & Nakashima, T. (2014). Features of the Japanese national dementia strategy in comparison with international dementia policies: how should a national dementia policy interact with the public health- and social-care systems? Alzheimer’s & Dementia, 10(4), 468–476.
Nakanishi, M., Hattori, K., Nakashima, T., & Sawamura, K. (2014a). Health care and personal care needs among residents in nursing homes, group homes, and congregate housing in Japan: why does transition occur, and where can the frail elderly establish a permanent residence? Journal of the American Medical Directors Association, 15(1), 76.e1–76.e6.
Nakanishi, M., Nakashima, T., Yamaoka, Y., Hada, K., & Tanaka, H. (2014b). Systems development and difficulties in implementing procedures for elder abuse prevention among private community general support centers in Japan. Journal of Elder Abuse & Neglect, 26(1), 31–43.
Sarma, S., Hawley, G., & Basu, K. (2009). Transitions in living arrangements of Canadian seniors: Findings from the NPHS longitudinal data. Social Science & Medicine, 68(6), 1106–1113.
Sheldon, T. (2002). Netherlands: long term care paid by compulsory insurance. British Medical Journal, 324(7353), 1542.
Stuck, A. E., Hammer, A., Minder, C. E., & Beck, J. C. (2002). Home visits to prevent nursing home admission and functional decline in elderly people: systematic review and meta-regression analysis. Journal of American Medical Association, 287(8), 1022–1028.
Study Group on Integrated Community Care. (2009). Report of the Study Group on Integrated Community Care. http://www.mhlw.go.jp/houdou/2009/05/dl/h0522-1.pdf. Accessed 28 Dec 2012.
Sutcliffe, C., Hughes, J., Chester, H., Xie, C., & Challis, D. (2010). Changing patterns of care coordination within old-age services in England. Care Management Journals: Journal of Case Management; Journal of Long Term Home Health Care, 11(3), 157–165.
Wimo, A., Ljunggren, G., & Winblad, B. (1997). Costs of dementia and dementia care: a review. International Journal of Geriatric Psychiatry, 12(8), 841–856.
Xu, H., Weiner, M., Paul, S., Thomas, J., Craig, B., Rosenman, M., Doebbeling, C. C., & Sands, L. P. (2010). Volume of home- and community-based Medicaid waiver services and risk of hospital admissions. Journal of the American Geriatrics Society, 58(1), 109–115.
Acknowledgments
The present study was a part of research project on the Integrated Community Care system in the Institute for Health Economics and Policy.
Funding
The study was funded by the Institute for Health Economics and Policy (PJ12301). The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of data; or preparation, review, and approval of the manuscript.
Conflict of Interest
Author N, Author S, Author M, and Author Y declare that they have no conflict of interest.
Informed Consent
The study did not collect any personal information. The questionnaire contained an introductory section explaining the purpose of the study, the voluntary nature of participation, and the assurance of anonymity of respondents. Participants were not required to sign consent forms; returning the questionnaire implied consent.
Ethical Treatment of Experimental Subjects (Animal and Human)
The study was approved by the Institute for Health Economics and Policy in Japan. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nakanishi, M., Shimizu, S., Murai, T. et al. “Ageing in Place” Policy in Japan: Association Between the Development of an Integrated Community Care System and the Number of Nursing Home Placements Under the Public Long-Term Care Insurance Program Among Municipal Governments. Ageing Int 40, 248–261 (2015). https://doi.org/10.1007/s12126-014-9215-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12126-014-9215-x