Evaluation and policy issues in Long-term care service delivery system for the elderly: centered on home care services

Abstract

This research report was written to suggest improvements of sub-system for delivering care services in long-term care insurance for the elderly. The research method mainly was the opinion survey targeted at care users and their family care-givers and commercial care providers. Long-term care services aim at improving and maintaining independent functional abilities (effectiveness issue) as well as financial stabilization (efficiency issue). The present long-term care service delivery system is divided into administrative and executive parts. The results of research are as follows. Generally speaking, care users and their family care-givers, or care providers had higher expression for executive parts, while in administrative parts was lower appraisal expressed than the average level. Firstly, the appraisal for needs assessment process including the determination of care level was lower, composed of visiting examiner's expertise, appropriateness of needs assessment items, etc. Secondly, the appraisal for issues in relation to care worker also was lower because there are lots of problems in training, care technic, their providing care quantity, etc. Thirdly, in the type of care benefit, day-care service was appraised high relatively from perspectives of improvement of ADLs and service utilization. Fourthly, in the type of facility operation, services delivered by free-standing facilities was appraised high relatively from various perspectives of delivery system. Fifthly, in the type of facility-operating body, appraisal by non-profit facility was high from perspectives of determination process of care level, while for-profit facility had higher appraisal for service utilization. Sixthly, in the type of facility-located area, and care level and income level of users, there were higher appraisals from urban-located facilities, and those with the second care-level, and higher income brackets respectively about care delivery system. Policy issues can be suggested that care-level assessment process be reviewed and examined closely. Besides, the objective tools measuring care service quality and reinforcement way of care worker's professionality and facility-operation standards be developed.