Provision of individualized care and built environment of nursing homes in Japan.

The Japanese government introduced the concept of 'unit-care model' (a large-scale facility which consists of small-scale groups) in 2003 into nursing homes. The governmental requirements are mainly about structure and staffing, not about the way of care provision. We aimed to examine if the requirements affect actual care provision. We sent a questionnaire to 300 unit-care model nursing homes and 900 conventional model nursing homes. 81 unit-care model facilities, 164 conventional care model facilities, and 103 conventional care facilities which created small groupings of people within larger buildings as an alternative to multiple small separate units (group-care model) were included in the analysis. We asked the administrator of the facilities about their principles for care provision by the dimensions of (1) wake-up, (2) dressing assistance in the morning, (3) meal, (4) bathing, (5) toileting assistance, and (6) spare time. We mainly asked about flexibility of scheduling and choice for menu, programs, and utensils. Unit-care model facilities and group-care model facilities were negatively associated with principles of fixed time and all-at-once assistance for waking up, dressing, and toileting. Residents had more choice for menu and programs for spare time in unit-care model facilities and group-care model facilities. The governmental requirements affected principles for care provision by defining the structure of facilities and staffing for desirable care provision. Raising fees for the group-care model can be an effective measure to achieve it in facilities with conventional structure.