Future Costs of Long-term Care in Japan and Sweden

Population aging is expected to increase long-term care (LTC) costs in both Japan and Sweden. This study projected LTC costs for 2010 through 2040 for different assumptions of population change, LTC need by age group and gender, and LTC provided per level of need and cost in Japan and Sweden. Population data were taken from the official national forecasts. Needs projections were based on epidemiological data from the Nihon University Japanese Longitudinal Study of Aging and the Swedish Survey of Living Conditions. Data on LTC provision by need and cost were taken from nine Japanese municipalities collected by assessments in the LTC insurance system and from surveys in eight Swedish municipalities. Total initial costs were calibrated to official national figures. Two projections based on two different scenarios were made for each country from 2010 to 2040. The first scenario assumed a constant level of need for LTC by age group and gender, and the other assumed a continuation of the present LTC need trends until 2025. For Japan, this resulted in a projected cost increase of 93% for the one and 80% for the other; for Sweden it was 52% and 24%, respectively. The results reflected differences in population aging and health development.

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Intersectionality: Mapping Critical Relations for Quality in Long-Term Care Research

Innovation in Aging ◽

10.1093/geroni/igaa057.127 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 39-39

Author(s):

Katie Aubrecht ◽

Ivy Bourgeault ◽

Tamara Daly

Keyword(s):

Long Term Care ◽

Term Care ◽

Social Divisions ◽

Care Workers ◽

Power Differentials ◽

Care Relationships ◽

And Gender ◽

Relations Of Power ◽

Status Of Care

Abstract Intersectionality is a useful method (Lutz, 2015) for interdisciplinary long-term care (LTC) research to advance a more critical understanding of how experiences of quality are shaped by mutually reproducing social divisions, identities and relations of power that shape LTC. This paper discusses insights from the “Mapping Care Relationships” stream of the Seniors – Adding Life to Years (SALTY) project, a pan-Canadian program of research examining clinical, social and policy perspectives on quality in LTC. “Mapping Care Relationships” mapped how promising approaches to care relationships are organized and experienced in LTC. From January 2018-August 2019 our team of nine researchers conducted rapid ethnographies in eight nursing homes, two in each of four provinces across Canada. We purposively observed and interviewed workers from a wide variety of positions and backgrounds, informed by an intersectionality approach. We traced how promising approaches in person-centred dementia care (PCDC) in particular may reify the subordinated status of care workers (some more than others) and reinforce inequities within LTC systems. In multiple LTC homes, front-line care workers described experiencing physical and emotional harm in care relationships with residents which caused them distress. However, consistent with a PCDC approach, the harm was attributed to ‘behaviours’ clinically symptomatic of dementia. In framing power differentials from a medical perspective, PCDC makes it possible to interpret harmful experiences as 'part of the job’ and something workers should know to expect, prevent, avoid, redirect, or ignore. Lutz, H. (2015). Intersectionality as method. DiGeSt. Journal of diversity and gender studies, 2(1-2), 39-44.

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Impact of Frailty on Medical and Long-Term Care Expenditures for the Elderly Age 75 or Over in Japan

Innovation in Aging ◽

10.1093/geroni/igaa057.569 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 176-176

Author(s):

Hiroto Yoshida ◽

Yuriko Kihara

Keyword(s):

Long Term Care ◽

The Elderly ◽

Elderly Age ◽

Term Care ◽

Intentional Weight Loss ◽

Long Term Care Insurance ◽

And Gender ◽

The Impact

Abstract This study examined the impact of frailty on medical and long-term care expenditures in an older Japanese population. The subjects were those aged 75 years and over who responded to the survey (March 2018) in Bibai, Hokkaido, Japan (n=1,203) and have never received certification of long-term care insurance at the survey. We followed up 867 individuals (72.1%) until the end of December 2018 (10 month-period). We defined frailty as a state in performing 4 items and over of 15 items which were composed of un-intentional weight loss, history of falls, etc. Among 867 subjects, 233 subjects (26.9%) were judged to be frailty group, and 634 subjects (73.1%) non-frailty group. We compared period to the new certification of long-term care insurance (LTCI), accumulated medical and long-term care expenditures adjusted for age and gender between the two groups during the follow-up period. Cox proportional hazard models were used to examine the association between baseline frailty and the new certification of LTCI. The relative hazard ratio (HR) was higher in frailty group than non-frailty group (HR=3.51, 95% CI：1.30-9.45, P=.013). The adjusted mean accumulated medical and long-term care expenditures per capita during the follow-up were significantly (P=.002) larger for those in the frailty group (629,699 yen), while those in the non-frailty group were 450,995 yen. We confirmed strong economic impact of frailty in the elderly aged 75 or over in Japan.

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The Influence of Race and Gender on Staff-Resident Interactions in Nursing Homes

Innovation in Aging ◽

10.1093/geroni/igaa057.599 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 185-185

Author(s):

Rachel McPherson ◽

Barbara Resnick ◽

Elizabeth Galik

Keyword(s):

Racial Differences ◽

Long Term Care ◽

Analysis Of Covariance ◽

Positive Interactions ◽

Term Care ◽

Race And Gender ◽

Significant Difference ◽

And Gender

Abstract Communication and interactions are an integral part of care in long-term care settings. Resident variables, such as race and gender, shape communication and interaction between staff and residents. The Quality of Interactions Schedule (QuIS) was developed to measure the quality of verbal and nonverbal interactions among nursing staff and older adults initially for those in acute care and later used as well in a variety of long term care settings. A quantified measurement of the quality of interactions between residents and staff was created to quantify the QuIS. The purpose of this study was to describe the gender and racial differences in scored quality of interactions. Data for the present study was based on baseline data from the Evidence Integration Triangle for Behavioral and Psychological Symptoms of Dementia (EIT-4-BPSD) implementation study. A total of 535 residents from 55 settings were included in the analyses. An analysis of covariance was conducted to determine a difference in QuIS scores between males and females while controlling for age. The second model tested for differences in QuIS scores between blacks and whites while controlling for age and gender. There was not a statistically significant difference in QuIS scores between male and female residents. There was a significant difference in QuIS scores between those who were black versus white, such that those who were black received more positive interactions from staff than those who were white. Future work should focus on a deeper examination of resident factors and staff factors that may influence these interactions.

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Aging, health expenditure, proximity to death, and income in Finland

Health Economics Policy and Law ◽

10.1017/s174413310800443x ◽

2008 ◽

Vol 3 (2) ◽

pp. 165-195 ◽

Cited By ~ 42

Author(s):

UNTO HÄKKINEN ◽

PEKKA MARTIKAINEN ◽

ANJA NORO ◽

ELINA NIHTILÄ ◽

MIKKO PELTOLA

Keyword(s):

Health Care ◽

Health Expenditure ◽

Long Term Care ◽

Health Care Expenditure ◽

Term Care ◽

Age And Gender ◽

And Gender ◽

Proximity To Death ◽

Naive Model

AbstractThis study revisits the debate on the ‘red herring’, i.e. the claim that population aging will not have a significant impact on health care expenditure (HCE), using a Finnish data set. We decompose HCE into several components and include both survivors and deceased individuals into the analyses. We also compare the predictions of health expenditure based on a model that takes into account the proximity to death with the predictions of a naïve model, which includes only age and gender and their interactions. We extend our analysis to include income as an explanatory variable. According to our results, total expenditure on health care and care of elderly people increases with age but the relationship is not as clear as is usually assumed when a naïve model is used in health expenditure projections. Among individuals not in long-term care, we found a clear positive relationship between expenditure and age only for health centre and psychiatric inpatient care. In somatic care and prescribed drugs, the expenditure clearly decreased with age among deceased individuals. Our results emphasize that even in the future, health care expenditure might be driven more by changes in the propensity to move into long-term care and medical technology than age and gender alone, as often claimed in public discussion. We do not find any strong positive associations between income and expenditure for most non-LTC categories of health care utilization. Income was positively related to expenditure on prescribed medicines, in which cost-sharing between the state and the individual is relatively high. Overall, our results indicate that the future expenditure is more likely to be determined by health policy actions than inevitable trends in the demographic composition of the population.

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Long-term Care Financing: Inserting Politics and Resource Allocation in the Debate Comment on "Financing Long-term Care: Lessons From Japan"

International Journal of Health Policy and Management ◽

10.15171/ijhpm.2019.88 ◽

2019 ◽

Vol 9 (2) ◽

pp. 77-79 ◽

Cited By ~ 1

Author(s):

Cristiano Gori

Keyword(s):

Resource Allocation ◽

Long Term Care ◽

Economic Resources ◽

The Other ◽

The Political ◽

Care Needs ◽

Term Care ◽

International Debate ◽

Financing Policies

The ageing of the countries’ populations, and in particular the growing number of the very old, is increasing the need for long-term care (LTC). Not surprisingly, therefore, the financing of LTC systems has become a crucial topic across the Organisation for Economic Co-operation and Development (OECD). In the last three decades, various financing policies have been carried out in different countries and the related international debate has grown. The latter has so far focused mostly on the different alternatives to collect economic resources to pay for care. The international debate needs now to focus also on other issues, so far less discussed. One is the politics of LTC: the degree and nature of the political interest in LTC, that affects the size and profile of public financing. The other is resource allocation: how different services and benefits are distributed among people with different care needs, that determines if resources made available are optimized. If we do not pay more attention to these issues – inextricably connected to policies aimed to collect funds – our understanding of LTC financing will remain inevitably limited.

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Population Aging and Long-Term Care Needs

Options for Aged Care in China: Building an Efficient and Sustainable Aged Care System ◽

10.1596/978-1-4648-1075-6_ch1 ◽

2018 ◽

pp. 79-99 ◽

Cited By ~ 2

Author(s):

John Giles ◽

Elena Glinskaya ◽

Yaohui Zhao ◽

Xinxin Chen ◽

Yuqing Hu

Keyword(s):

Long Term Care ◽

Population Aging ◽

Care Needs ◽

Term Care

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The Economics of Long-Term Care

Sustainable Health and Long-Term Care Solutions for an Aging Population - Advances in Medical Diagnosis, Treatment, and Care ◽

10.4018/978-1-5225-2633-9.ch001 ◽

2018 ◽

pp. 1-18

Author(s):

Peter P. Yuen

Keyword(s):

Conceptual Framework ◽

Long Term Care ◽

Population Aging ◽

Clear Understanding ◽

Term Care ◽

Developed Economies ◽

Care Services ◽

Key Concepts ◽

Major Transformation

This chapter presents key concepts of economics relevant to the financing and delivery of long term care services. It first examines the magnitude of population aging in developed economies, and the associated implications for long term care. Key economic concepts relating to the demand, supply and financing of long term care services are then discussed. Policies, practices and major models of financing of long term care are further explored followed by a presentation of the conceptual framework for reform. It concludes that in view of the magnitude of the problem, incremental changes in the existing systems are unlikely to be adequate. A clear understanding of the economic concepts to underpin major transformation of existing systems and policies that do not align with populations trends is urgently needed.

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Informal caregivers in Chile: the equity dimension of an invisible burden

Health Policy and Planning ◽

10.1093/heapol/czz120 ◽

2019 ◽

Vol 34 (10) ◽

pp. 792-799 ◽

Cited By ~ 1

Author(s):

Pablo Villalobos Dintrans

Keyword(s):

Long Term Care ◽

Population Aging ◽

Large Fraction ◽

Informal Caregivers ◽

Developed Countries ◽

Lower Income ◽

Vicious Cycle ◽

Care Needs ◽

Term Care

Abstract Population aging is driving a process of increase in long-term care needs in Chile and many countries around the world. In this context, this article asks about the consequences of this increase in informal caregivers, emphasizing the inequity issues arising from these changes. Using the CASEN 2017 survey, caregivers are identified and matched to people with long-term care needs. Results show that most caregivers are women, and a large fraction of them are also elderly; this is similar to what has been found previously in developed countries. Caregivers have fewer opportunities than non-caregivers, which translates into lower income-generating ability and higher poverty. The nature of these tasks creates a vicious cycle in which people get trapped with increasing needs and fewer resources to meet them. Important differences arise between caregivers and the rest of the population. Even more concerning is that these disparities are avoidable to some extent, adding an equity dimension to the problem. This emphasizes the need for the generation of policies that will support caregivers and meet their needs.

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