Mass evacuation and increases in long-term care benefits: Lessons from the Fukushima nuclear disaster

Abstract

BackgroundThough mass evacuation may increase the need for long-term care (LTC) services, how the need for LTC services increases and how the public LTC system affects it is not well understood. We evaluated changes in public LTC benefits for the people living in the mandatory evacuation areas established after the 2011 Fukushima nuclear disaster and examined the roles of the universal LTC insurance system in Japan.MethodsIn order to evaluate the effect of the mandatory evacuation on LTC benefits, we examined the trends of LTC benefits in the Fukushima evacuation group and the nationwide non-evacuation group. We first decomposed per-elderly-individual benefits at the municipality level into the LTC certification rate and per-certified-individual benefits, and then implemented difference-in-differences analysis using these variables as outcomes.ResultsPer-elderly-individual benefits significantly increased from 2012 onward in the evacuation group, and this was explained by an increase in the certification rate rather than in per-certified-individual benefits. Increases in per-elderly-individual benefits and the certification rate in the post-disaster period were observed in all but the highest care level, and the corresponding outcomes for the highest care level decreased immediately after the disaster. We also found that the increase in the certification rate had been mostly realized by an increase in the number of certified individuals.ConclusionsThe increase in LTC benefits can be associated with the impact of the increase in the number of people newly certified to receive LTC benefits after the mandatory evacuation. In order to cope with the increase in utilization of long-term care and associated costs after disasters in aging societies, both formal long-term care services and social support for informal care for evacuees should be considered important.

Long‐term care issues in a municipality affected by the great East Japan earthquake: A case of Katsurao Village, Fukushima prefecture

“…Regarding long‐term care insurance premiums, an increase in the number of older people requiring long‐term care and a decrease in the number of residents who pay the premium was found to affect its increase. Morita et al 15 showed that the cost of care in the disaster area increased with the use of light care, and Hasegawa et al 6 also showed a similar increase, especially in the evacuation area after the earthquake. Kobashi et al 16 revealed that older adults comprise the majority of the returning population, particularly between the age of 65 and 75 years.…”

Long-term Care Utilization Discrepancy Among the Elderly in Former Evacuation Areas, Fukushima

“…Previous studies have shown that the LTC costs for residents over 65 years in the former evacuation areas in Fukushima prefecture were approximately 1.5 times higher in 2012-2014 than before the earthquake. 3,6 This was caused by a marked increase in the utilization ratio of mild-degree LTC presumably due to the loss of informal at-home care. Currently, there is not enough information on whether the loss of informal care is more prominent in the evacuee or returnee groups hence, more information on family members is needed to properly understand the health care needs of those living in former evacuation areas.…”

“…When the elderly request to use the national public LTC service, municipal governments conduct interviews and surveys for living situation concerns. 3 The level of required LTC is determined by the Care Needs Certification Board, which is comprised of medical professionals and other specialists. 3…”

“…3 The level of required LTC is determined by the Care Needs Certification Board, which is comprised of medical professionals and other specialists. 3…”

Effects of the 2018 Japan Floods on long-term care insurance costs in Japan: retrospective cohort study

“…Although the increase of disaster-related LTCI costs is an urgent issue in an aging society, few studies have examined the effect of disasters on LTCI costs. Community-based ecological studies showed changes in LTCI service after the GEJE [ 28 – 30 ]. However, there are no studies that examine the ever-changing effect of a disaster at the individual level chronologically and precisely.…”