Changes in functional status of recipients using long-term care services according to the type of long-term care service

Abstract

Background: With the introduction of the government's long-term care insurance (LTCI) system, the number of users of long-term care (LTC) service increased. And the physical functional status of LTCI beneficiaries improved and the burden of caregivers decreased. However, depending on the type of LTC services used by the elderly, changes in physical function status and symptoms of recipients appear differently. Therefore, the purpose of this study is to analyze the characteristics of LTC service use for beneficiaries who use LTC services for the elderly and to identify changes in the functional status of users according to the types of LTC services. Materials and Methods: The data were drawn from the 2009 to 2013 National Health Insurance Service (NHIS)-Senior cohort data. The analytic sample consisted of 3,415 beneficiaries in receipt of LTC services. The subject that followed up at least two times after receiving the first grading evaluation among LTCI service users who maintained grades 1 and 2 were included. The independent variable of interest was the type of LTCI services, classified as home-based care, public institutional care service, or private facility institutional care service. The primary outcome was overall LTC score, with higher scores indicating more severe LTC needs. In this study, factors that may affect medical use were controlled, and the linear mixed effects model estimating (LMM) method was used as a statistical analysis method to examine the time-lagged relationship between type of LTCI services and functional status. Results: In a multivariate analysis that controlled other factors, the average functional status score of public facility services was significantly highest (93.01), the average functional status score of home-based care was higher (91.29) and the average functional status score of private facility services was significantly lowest (89.49) at baseline (p=0.0010). Compared to home-based care, public facility services (β= -1.03, p=0.2852) was correlated with decreases in time-varying functional status score. Compared to home-based care, private facility services (β= -2.65, p<0.0001) was significantly correlated with decreases in time-varying functional status. Conclusion: The condition of recipients who used public facility services improved more than those who used home services, and the condition of recipients who used private facility services improved the most than recipients who used other LTC services. Therefore, it is considered that public facility service and home-based service users need more LTC care. The government needs to come up with measures to adjust the quality of services so that even if LTC users use different types of LTC services, there is no difference in the status changes of beneficiaries. In addition, a health care policy should be established so that the elderly can lead a healthy old age by providing various high-quality LTCI services for the elderly.