# Impact of Introduction Timing on Home-Visit Rehabilitation Outcomes for Older Adults Supported by the Japanese Nursing Care Insurance System

## TL;DR

This study explores how the timing of home-visit rehabilitation affects outcomes for older adults in Japan's nursing care insurance system.

## Contribution

The study identifies that initiating home-visit rehabilitation soon after hospital discharge may improve daily living independence in older adults.

## Key findings

- Group B showed higher care levels at the start of rehabilitation.
- Group B had significantly higher improvements in BI and FAI scores.
- Group B required more frequent rehabilitation sessions.

## Abstract

Background

In the aging Japanese society, home-visit medical and nursing services are becoming essential for the elderly population. Home-visit rehabilitation is a service available based on the nursing care insurance system in Japan. However, little is known about the association between home-visit rehabilitation introduction timing (during in-home life or soon after discharge from a hospital or a nursing facility) and clinical outcomes for older adults. This study aimed to examine the association between initiation timing and clinical effectiveness.

Method

This exploratory retrospective study included 212 older adults who received home-visit rehabilitation using nursing care insurance from November 2018 to April 2023. Participants were divided into two groups: those who initiated home-visit rehabilitation while living at home (Group A) and those who started it soon after being discharged from a hospital or a nursing facility (Group B). Clinical variables were collected, and functional outcomes were compared between the two groups using the Barthel Index (BI), Frenchay Activities Index (FAI), levels of support or long-term care needed, degree of being bedridden, and dementia rating. Statistical significance was defined as a p-value < 0.05.

Results

Compared to older adults in group A, those in group B had a higher care level when home-visit rehabilitation began. The degree of independence in daily living and FAI scores were significantly lower in Group B. The frequency of home-visit rehabilitation was relatively high in the same group. The changes in BI and FAI scores before and after the initiation of home visit rehabilitation and the proportion of older adults who maintained or improved their daily life independence rank were significantly higher in group B.

Conclusions

Frequent home-visit rehabilitation initiated soon after hospital discharge was associated with the maintenance and improvement of activities of daily living (ADLs) and instrumental activities of daily living (IADLs) in older adults, although this association is likely confounded by higher rehabilitation intensity in the post-discharge group.