A study of the impact of services used by the elderly on changes in the level of care required

Introduction: Since the long-term care insurance system (LTCIS) was introduced in Japan in 2000, both the number of the eligible recipients of care and the total cost of the system have been risen from 2.18 million to 6.44 million, three times, over the past 18 years. In view of the sustainability of this system, the most recent discussions on this system have considered restricting recipients' access to services. The principle of the manegement measures should be the optimisation of each recipients' long-term care services, but the basis for 'optimisation' remains unclear. This study focuses on elderly people certification of needed long-term care, and gathers data on the 'optimisation' of these services by identifying the relationship between the long-term services they used and changes in their care levels, as well as their costs. Method: In this study, we included 5925 elderly people certification of needed long-term care after June 2015, whose duration of care was between 12 and 36 months and those care level from 1 to 4. Based on changes in recipients' care levels, we compared costs between two groups, the maintenance and improvement group (maintenance group) and the deterioration group with Kruskal-Wallis test and Paired-samples t-test. Highlights, Results, or Key Findings: In home-visit long-term care services, the costs of the maintenance group were significantly lower than those of the deteriorating group with each care levels. In outpatient day long-term care services, which have the largest number of users among long-term care services, with care level 1 and with care level 2, both costs of the deteriorating group in the first month and in the monthly average are significantly higher than those of maintenance group. On the other hand, with care level 4, which require a huge amount of care services, there was no significant difference between the deterioration and maintenance groups in the first month of outpatient day long-term care services' cost, but home-visit nursing services' cost was higher in the deterioration group. Furthermore, for recipients who used home-visit nursing services from the first month, the costs from the first month and monthly average after second month onwards were USD 296.9 and USD 347.8 in the maintenance group with the monthly average being significantly higher, but were not significantly different in the deterioration group. This is important because it suggests that home nursing may have influenced the maintenance of service users' ADLs. Conclusion: For LTCIS, defining 'adequate long-term care services' and explaining this to the public in an easy-to-understand manner will contribute significantly to the sustainability of this system. The study found that people with a high of independence and care levels of 1 or 2 received more care services in the deteriorating group than in the maintenance group, regardless of the type of care services, while evidence suggests that for people with a low of independence and care level of 4, home nursing care is beneficial in maintaining ADLs. This is an important finding when discussing the "optimization" of long-term care services.