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

OBJECTIVE: In April 2000, the system for caring for the elderly in Japan was changed drastically with the launch of new long-term care insurance. Unlike the previous system, the maximum monthly amount of insured services is now decided solely by an applicant's physical condition, regardless of family support. We investigated whether the presence and kinship of a family caregiver still affect service use under the new system. DESIGN: A cross-sectional, mailed, self-administered questionnaire survey and analysis using multiple logistic regression. SETTING: One month after the introduction of long-term care insurance in Japan. PARTICIPANTS: The main family caregivers of 237 applicants for long-term care insurance with a caregiver and 33 applicants without a caregiver, living in the community in one city. OUTCOME MEASURES: The applicants' sex, age, and eligible care level, existence of a family caregiver, family caregiver's sex, age, and kinship, and service use for each service covered by long-term care insurance. RESULTS: Caregiver factors significantly affected use of the main services. The most popular service, nursing-home daycare, was utilized most when a wife was caring for her husband. As the level of care increased, this service was utilized less. Home help, the second most popular service, was most utilized when a wife was caring for her husband or when there was no caregiver. CONCLUSION: 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.