Factors that affect older Japanese people's reluctance to use home help care and adult day care services.

The purpose of this study was to examine the factors related to the reluctance of older Japanese people to utilize home help services and day services. Home help services consist of three different types of services (i.e., assisting in bathing and toileting, doing household choirs, such as cooking and laundry, and counseling) and are provided by visiting home helpers at the homes of older people. Day services are services (e.g., providing bathing and meals, monitoring the health status of older people, and counseling) that are provided at day service centers in the community to improve the physical and psychological functioning of older people and to help the burden of caregiving of family members. The data used in the study came from the first wave of the Nihon University Japanese Longitudinal Study of Aging, conducted in November 1999 (and again in March 2000 for those people who had been unable to respond to the initial survey). Face-to-face interviews were conducted with a national probability sample of 6,700 people aged 65 and older. Logistic regression analyses were used to analyze factors that were thought to be related to older people's reluctance to use services. Approximately, one half of the respondents indicated reluctance to use home help services, and one quarter of the respondents showed reluctance to use day services. Respondents who were female and who lived in urban areas showed a higher probability of feeling reluctant about using both home-help and day services. Also, respondents who had had caregiving experience using these two types of services showed a lower probability of feeling reluctant about using the services. Furthermore, respondents who were older and had income showed a higher probability of feeling reluctant about using day services, whereas those who had had caregiving experience and who participated in social activities showed a lower probability of feeling reluctant about using day services. According to the 1999 survey, there were still many older Japanese people who felt reluctant about using either type of care service. But it is expected that the quality of services under Kaigo Hoken (the mandatory public long-term care social insurance system) will improve further and that older people's attitudes toward service utilization will change for the better. In the meantime, professional service providers will have to be sensitive to older people's perceptions about service utilization if they would like to continue to contribute to the improvement process of Kaigo Hoken as a positive force.