title: Effect of in-home and community-based services on the functional status of elderly in the long-term care insurance system in Japan.
abstract: BACKGROUND
  Japan is setting the pace among aging societies of the world. In 2005, Japan became the country with the highest proportion of elderly persons in the world. To deal with the accelerated ageing population and with an increased demand for long-term care services, in April 2000 the Japanese government introduced a mandatory social Long-Term Care Insurance System (LTCI), making long-term care services a universal entitlement for elderly. Overseas literature suggests that the effectiveness of a home visiting program is uncertain in terms of preventing a decline in the functional status of elderly individuals. In Japan, many studies regarding factors associated with LTC service utilization have been conducted, however, limited evidence about the effect of LTC services on the progression of recipient disability is available.
  
  
  METHODS
  Data were obtained from databases of the LTC insurer of City A. To examine the effect of in-home and community-based services on disability status of recipients, a survival analysis in a cohort of moderately disabled elderly people, was conducted.
  
  
  RESULTS
  The mean age of participants was 81 years old, and females represented 69% of the participants. A decline or an improvement in functional status, was observed in 43% and 27% of the sample, respectively. After controlling for other variables, women had a significantly greater probability of improving their functional status during all phases of the observation period. The use of "one service" and the amount of services utilized (days/month), were marginally (p = < 0.10) associated with a greater probability of improving their functional status at 12 months into the observation period.
  
  
  CONCLUSIONS
  The observed effects of in-home and community-based services on disability transition status were considered fairly modest and weak, in terms of their ability to improve or to prevent a decline in functional status. We suggest two mechanisms to explain these findings. First, disability transition as a measure of disability progression may not be specific enough to assess changes in functional status of LTCI recipients. Secondly, in-home and community-based services provided in City A, may be inappropriate in terms of intensity, duration or quality of care.
authors.affiliation: Department of Health Services Research, Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tenno-dai Tsukuba, Ibaraki 305-8575, Japan.
authors.forename: Pedro
authors.initials: P
authors.lastname: Olivares-Tirado
authors.forename: Nanako
authors.initials: N
authors.lastname: Tamiya
authors.forename: Masayo
authors.initials: M
authors.lastname: Kashiwagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003153:Community Health Services / Q000706:statistics & numerical data*; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data; D005260:Female; D006299:Health Services for the Aged / Q000191:economics* / Q000592:standards; D006305:Health Status Indicators; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007353:Insurance, Long-Term Care / Q000706:statistics & numerical data*; D007564:Japan; D053208:Kaplan-Meier Estimate; D008134:Long-Term Care / Q000191:economics*; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D016016:Proportional Hazards Models