Medicaid nursing facility rates, capacity, and utilization: a structural analysis

What factors influence older people's intention to enrol in nursing homes? A cross-sectional observational study in Shanghai, China

OBJECTIVES

Given the increasing need of long-term care and the low occupancy rate of nursing homes in Shanghai, this study attempts to explore what factors influence older people's intention to enrol in nursing homes.

DESIGN

A cross-sectional observational study based on the theory of reasoned action was conducted. Survey data were collected from subjects during face-to-face interviews. Structural equation modelling was employed for data analysis.

SETTING

This study was conducted in six community health service centres in Shanghai, China. Two service centres were selected in urban, suburban and rural areas, respectively.

PARTICIPANTS

A total of 641 Shanghai residents aged over 60 were surveyed.

RESULTS

Structural equation modelling analysis showed that the research model fits the data well (χ²/df=2.948, Comparative Fit Index=0.972 and root mean squared error of approximation =0.055). Attitude (β=0.41, p<0.01), subjective norm (β=0.28, p<0.01) and value-added service (β=0.16, p<0.01) were directly associated with enrolment intention, explaining 32% of variance in intention. Attitude was significantly influenced by loneliness (β=-0.08, p<0.05), self-efficacy (β=0.32, p<0.01) and stigma (β=-0.24, p<0.01), while subjective norm was significantly influenced by life satisfaction (β=-0.15, p<0.01) and stigma (β=-0.43, p<0.01).

CONCLUSIONS

This study advances knowledge regarding the influencing factors of older people's intention to enrol in nursing homes. It suggests that Chinese older persons' perceived stigma has the strongest indirect effect on their intention to enrol in nursing homes. This is unique to the Chinese context and has practical implications for eldercare in China and other Asian countries with similar sociocultural contexts.

Impact of a fixed price system on the supply of institutional long-term care: a comparative study of Japanese and German metropolitan areas

BACKGROUND

The need for institutional long-term care is increasing as the population ages and the pool of informal care givers declines. Care services are often limited when funding is controlled publicly. Fees for Japanese institutional care are publicly fixed and supply is short, particularly in expensive metropolitan areas. Those insured by universal long-term care insurance (LTCI) are faced with geographically inequitable access. The aim of this study was to examine the impact of a fixed price system on the supply of institutional care in terms of equity.

METHODS

The data were derived from official statistics sources in both Japan and Germany, and a self-administered questionnaire was used in Japan in 2011. Cross-sectional multiple regression analyses were used to examine factors affecting bed supply of institutional/residential care in fixed price and free prices systems in Tokyo (Japan), and an individually-bargained price system in North Rhine-Westphalia (Germany). Variables relating to costs and needs were used to test hypotheses of cost-dependency and need-orientation of bed supply in each price system. Analyses were conducted using data both before and after the introduction of LTCI, and the results of each system were qualitatively compared.

RESULTS

Total supply of institutional care in Tokyo under fixed pricing was found to be cost-dependent regarding capital costs and scale economies, and negatively related to need. These relationships have however weakened in recent years, possibly caused by political interventions under LTCI. Supply of residential care in Tokyo under free pricing was need-oriented and cost-dependent only regarding scale economies. Supply in North Rhine-Westphalia under individually bargained pricing was cost-independent and not negatively related to need.

CONCLUSIONS

Findings suggest that publicly funded fixed prices have a negative impact on geographically equitable supply of institutional care. The contrasting results of the non-fixed-price systems for Japanese residential care and German institutional care provide further theoretical supports for this and indicate possible solutions against inequitable supply.