Home and Community Care Digest

Home and Community Care Digest December 2002 : 0-0

Cross-cultural analysis of family caregivers may help explain variations in home care utilization; Caregiver factors affect Japanese home care service utilization


In planning an adequate supply of services and promoting their effective use, Canadian decision makers must understand the effects of the family caregivers across different cultural groups. This study focused on home care services used in Japan. Researchers found that the presence and kinship status of family caregivers have diverse effects on the type of services used.
Background: When planning an adequate supply of home care services and promoting their effective use, Canadian decision makers must understand additional factors besides patient health status that affect utilization rates. The presence of family caregivers and their roles are an important set of factors that may have diverse influences across different cultural groups. US and Japanese studies have shown different effects of family caregivers on home care service utilization, perhaps reflecting differences in family structures in the 2 nations. Under Japan's new long term insurance system, the only limit on home care provision is the patient's physical condition. This change has in part been guided by a commitment to making elder care a societal responsibility, since in the past elder care was the private responsibility of Japanese families.

Method: This study investigated the effect of family caregivers on home care service utilization under the new system. A postal survey (response rate = 54%) was conducted among 597 urban home care patients. Data were collected on patient health status, services utilized, and the existence, age, sex, and kinship relationship of the family caregiver. Data for patients with and without caregivers were analyzed separately.

Findings: The type of service utilized was affected by the presence and kin relationship of the caregiver. Among patients without caregivers, the most popular service (52%) was 'home help' (e.g. housekeeping). In contrast, less than a quarter of the patients with caregivers utilized this service. This is important to note since the number of elderly Japanese living alone is increasing rapidly, hence demand is likely to grow. Among patients with caregivers, the most popular service was daycare (34%). Daycare was also popular among those without caregivers (42%). Results were further analyzed in terms of the kinship relationship of the caregiver to the patient. Daughters-in-law caring for mothers and wives caring for husbands utilized home care services most; while sons and daughters caring for mothers utilized services least. Wives utilized all services more frequently than husbands, except for housekeeping. Daughters-in-law utilized home care services nearly twice as often than daughters. For all care dyads, respite was used most and housekeeping used least, with the exception of husbands caring for wives. Husbands used respite least, and used visiting nurse, bathing, and housekeeping services most. Wives utilized the broadest range of services, perhaps because wives are older than other family caregivers. An older caregiver was an eligibility criterion under the former system, but not under the new system.

Conclusions: Family caregiver factor research has been undertaken in several cultures. Canadian policy makers may need to undertake cross-cultural analyses to understand home care needs across diverse populations. Since caregiver factors are not considered under the new Japanese insurance system, the new system may not meet the needs of patients, such as elderly people who have low care needs, but whose caregivers require additional support.

Reference: Nanako T, Yamaoka K, Yano E: Use of home health services covered by new public long-term care insurance in Japan: Impact of the presence and kinship of family caregivers. International Journal for Quality in Health Care 2002; 14(4); 295-303.


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