Institutionalization Among Older Adults in Japan

This study is to explore the risk factors affecting the possibility of institutionalization for the elders after the launch of the Long Term Care Insurance (LTCI) in Japan, 2000. Previous research shows that the level of informal caregiving, and caregiver’s capability, rather than the older adult’s declining function, were the key risk factors for institutionalization before the LTCI. The effect of LTCI services have seldom been examined from the perspective of its impact on risk for institutionalization. Using ordinal logistic regression, we analyze the claims data on LTCI service use in one city in Japan from 2000 to 2006. The preliminary results show that after the launch of LTCI, the caregiver’s preference for services is the significant risk factor for institutionalization, among other predictors related to risk of institutionalization, such as living arrangement, characteristics of both the care recipients and the caregivers. LTCI provides diverse home-based and institutional services for families and individuals, and in our claims data, those who utilized home-based services the most turn out to be the least likely to be institutionalized. And for the elders institutionalized the most, their primary caregivers had expressed their preferences for institutional care services at the time when applying for the LTCI services, and they utilized the least home-based services. Therefore, we gather some evidence that LTCI had provided sufficient home-based services to reduce the possibility of institutionalization due to lack of informal services. Despite the home-based services provided, the key risk for institutionalization is the primary caregivers’ preference---whether they prefer more involvement of LTCI services or not, and whether they prefer the services at home or in institutions. Therefore, we conclude that the LTCI services have a double-edged effect on family aging care, and the family has great influence on whether the older adult will be institutionalized or not.