[Problems impeding the introduction of care services under the long-term care insurance system].

Objective: To identify problems currently impeding the introduction of care services to seniors who are not yet taking advantage of such services despite the need for some kind of in-home care, and to examine effective solutions by creating a model that clarifies relationships among these problems based on covariance structural analysis.

Methods: An anecdotal self-completion questionnaire was sent by mail to public health nurses who provide consultations to seniors in 657 locations throughout the mainland Japan, Honshu. The cases targeted in this survey were seniors for whom the introduction of care services was perceived to be difficult. Respondents were asked to relate one particularly memorable case encountered since April 2000 in which intervention assistance was provided through home visits. The survey consisted of 43 questions, including demographic information, basic case data, the outcome of intervention assistance in the case cited, and obstacles to introducing nursing services. We analyzed the 311 valid responses received (valid response rate: 47.3%). After performing factor analysis on the problems that were considered to impede the introduction of care services, we examined the relationships among these problems using covariance structural analysis and selected the model that best fit the data.

Results: 1) Problems that were considered to impede the introduction of care services were extracted from the results of an item analysis and factor analysis as follows. Factor 1: "Resistance to changing lifestyle." Factor 2: "Relative's lack of understanding or cooperation." Factor 3: "Lack of ability to handle procedures and contracts." Factor 4: "Lack of informal support." Factor 5: "Resistance to undergoing medical exams." 2) We performed a covariance structural analysis using the five factors derived from the factor analysis as the latent variables, and selected the best-fitting model, in which GFI = 0.929, AGFI = 0.901, and CFI = 0.950. The model showed that factors 3, 4, and 5 overlapped with factors 1 and 2 in impeding the introduction of nursing services, thus impeding the introduction of care services.

Conclusion: The relationships among the problems impeding the introduction of care services were clarified using an anecdotal survey administered to public health nurses. To provide adequate support to these seniors, efforts must be made to examine community-based methods of providing intervention assistance tailored to the needs of individuals, as well as to examine systems of identifying and accommodating seniors who require assistance because they lack the ability to handle bureaucratic procedures themselves and also lack other sources of support.