Profile of Long-Term Care Recipients Receiving Home and Community-Based Services and the Factors That Influence Utilization in Taiwan

Abstract

In response to the irreversible aging trend, the Taiwan government has promoted the Long-Term Care (LTC) policy 1.0 launched in 2007 and the LTC policy 2.0 reform since 2016. This study aimed to explore the utilization of formal home and community-based care under LTC policy 1.0 to add scientific support for the on-going LTC policy 2.0 reform. Methods: By using Andersen and Aday’s behavioral model of healthcare utilization, the long-term care dataset was analyzed from 2013 to 2016. A total of 101,457 care recipients were identified after data cleaning. Results: The results revealed that about 40.7% of the care recipients stayed in the care system for more than two years. A common factor influencing the length of home and community-based services (HCBS) utilization period included need factors, where more dependent recipients leave the LTC system regardless of their socio-economic status. However, the utilization period of non-low-income households is significantly affected by the level of service resources. Conclusion: For long-term care needs, the phenomenon of a short utilization period was concerning. This study adds information which suggests policy should reconsider care capacity and quality, especially for moderate to severely dependent recipients. This will allow for better understanding to help maintain care recipients in their own communities to achieve the goal of having an aging in place policy.

Social factors influencing utilization of home care in community-dwelling older adults: a scoping review

“…Most of the studies (44 studies or 66.7%) were secondary data analyses of existing databases, [ 42 , 44 , 45 , 47 , 50 , 51 , 54 , 57 , 59 – 63 , 65 , 66 , 68 , 69 , 71 , 72 , 74 – 76 , 80 , 82 , 83 , 87 , 90 , 93 – 96 , 100 – 102 ]; of which, ten of these studies used econometric analytic techniques [ 41 , 43 , 56 , 64 , 77 , 84 , 86 , 91 , 97 , 98 ]. Other study designs included nine cross-sectional surveys [ 40 , 48 , 55 , 58 , 79 , 81 , 85 , 103 , 105 ], five longitudinal cohort studies [ 46 , 49 , 70 , 78 , 88 ], four retrospective cohort studies [ 73 , 89 , 99 , 104 ], and one each of a case control [ 53 ], quasi experimental [ 52 ], cluster randomized controlled trial [ 92 ] and quality improvement study [ 67 ].…”

“…For studies supporting higher propensity among women, women had a higher probability of first-time use of any services, were more likely to seek out home care services and higher probability of using support services [ 74 , 93 , 94 ]. Another study suggested that increased home care use can be explained by older age in women recipients and being widowed having married older men.…”

“…Higher education was, however, associated with increased home care intensity. Deindl and Brandt (2017) found that highly educated older adults received more hours per week of formal and combined (formal and informal) home care compared to those with low or medium education [ 54 ]; and Shih and colleagues (2020) found a positive association between years of education and length of time in the home care system [ 93 ]. Figure 3 shows that the measures of education between studies varied greatly (e.g.…”

“…While 11 studies suggested that living alone increased the likelihood of having received home care, nine other studies showed a null relationship. However, living alone was associated with greater amounts of home care (intensity) measured by cost [ 48 , 60 ], time [ 93 ] and number of home health visits per week [ 104 ]. In Belgium, the total average formal support cost borne by the National Institute of Health and Disability Insurance (which covers 99% of the population) for older adults with IADL functional limitations was 725 EUR per month; the cost decreased with cohabitant carers and increased when living without a carer [ 48 ].…”

Integrating Socioeconomic Status and Spatial Factors to Improve the Accessibility of Community Care Resources Using Maximum-Equity Optimization of Supply Capacity Allocation

“…Community-based care resources could include community care stations, daycare providers, long-term care institutions, and medical institutions that are located in communities and serve the people who live there. Studies using keywords such as "community care", "elderly care", and "geographical accessibility" have focused on the geographical accessibility in healthcare resources, and related analyses highlight the variables of distance, population demand, and number of medical resource suppliers [16,17,20,28,[32][33][34][35][36][37], all of which influence the utilization of home and community-based services among recipients of long-term care in Taiwan [38], as well as the accessibility of institutional healthcare facilities for the elderly [39][40][41]. Study of care resources in non-medical communities focus on the business model of community-based care institutions [42] and the types of services provided to people with disabilities and the elderly [43].…”