Caregivers' Decisions on Placement of Family Members in Long-Term Care Facilities in Japan: Analysis of Caregiver Interviews

By Tamiya, Nanako; Chen, Li-Mei et al. | Social Behavior and Personality: an international journal, April 2009 | Go to article overview

Caregivers' Decisions on Placement of Family Members in Long-Term Care Facilities in Japan: Analysis of Caregiver Interviews


Tamiya, Nanako, Chen, Li-Mei, Sugisawa, Hidehiro, Social Behavior and Personality: an international journal


In April 2000, the Japanese government started the national long-term care insurance in anticipation of the demand for long-term care (LTC) services by the largest aging population in the history of the world, with approximately one in every four persons then aged 65 years and older (Ministry of Health and Welfare, 2004). In particular, the goal of the national LTC insurance was to encourage continuing care in their own homes for older adults by commercializing and partially subsidizing the delivery of home healthcare services.

However, contrary to the government's hopes, institutionalization has grown in Japan. Statistical data from 2004-2007 (Ministry of Health and Welfare [MHF], 2007) indicated that there has been a 14% increase in use of special nursing homes for older adults (see Table 1 for details on LTC facility terms and characteristics). Out of 2,912,600 LTC insurance beneficiaries, 406,400 persons or approximately 7% were in special nursing homes (MHF, 2007). There has also been a steady growth of nursing home construction initiated by the government; the number of nursing homes has increased 30% between 2000 and 2006 (MHF, 2007). Meanwhile, home care services, including personal care, nursing care, and rehabilitation, decreased by 12%.

To discourage nursing home use among insurers, an amendment was made to the LTC insurance plan in October 2005 by raising the copayment for meal and "hotel" (i.e., room) costs. However, recent research still suggests continuing growth in utilization of nursing home facilities despite the amendment (Hayashihara, Tamiya, Takahaski, Kashiwagi, & Okubo, 2008).

There are three possible reasons why there has been an increase in demand for institutionalization in Japan. First, the constitution of families has changed over the years. Extended family households traditionally performing filial piety (i.e., adult children taking care of their aging parents) are decreasing significantly. In 1995, approximately 60% of all households were nuclear families consisting of an average of 2.82 persons per household (MHF, 1998). Instead, households consisting of older adults living alone or living only with spouses have increased 50% during 1993-2003. Among households with at least one family member aged 65 and older, 28% were older adults living only with spouses and 24% were older adults living alone (MHF, 2005). Secondly, Japanese women who were traditionally the primary caregivers for older adults, have been participating increasingly in the workforce. In 1996, the number of working women surpassed the number of homemakers (MHF, 1998). Finally, Japanese views on the role of families are changing. There has been a significant drop in the number of people who considered that it was children's responsibility to be caregivers for their elderly relatives, and that it was the family's role to look after their emotional well-being (27%; MHF, 1998).

The goal in this study was to explore Japanese caregivers' decisions to place their older family members in LTC facilities. In particular, we were interested in investigating the evidence of caregivers' conflict during the decision-making process. This study is unique because rarely accessible data were used from primary caregiver interviews during the transitional phase at a Geriatric Intermediate Care Facility (GICF), where length of stay is limited to 3 months for older patients who do not require hospitalization. Older patients' records were also analyzed using statistical methods.

There have been developments of theoretical conceptualizations to study the institutionalization process, incorporating caregiver characteristics, stressors, and psychological indicators. In particular, Pearlin's stress process model (Pearlin, 1999; Pearlin, Menaghan, Lieberman, & Mullan, 1981; Pearlin, Mullan, Semple, & Skaff, 1990) has been highly relevant for a multidimensional approach to caregivers' stressors and their impact on outcomes. …

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