Service-Use Subtypes and Caregiver Burden in Home-Living Adults with Severe Care Needs in Japan

TL;DR

This study identifies different patterns of care service use among home-living adults in Japan with severe care needs and finds that certain service types are linked to lower caregiver burden.

Contribution

The study introduces a novel approach to categorizing service-use subtypes and links them to specific caregiver burden domains.

Findings

Three service-use subtypes were identified: outpatient/day services, multi-component home visits, and outpatient/day rehabilitation.

The multi-component home-visit subtype was associated with lower overall caregiver burden and reduced emotional and existential burdens.

Appropriate service combinations may help reduce caregiver strain in community-based care systems.

Abstract

As Japan transitions from hospital- to community-centered care, the burden on family caregivers is a growing concern. We aimed to identify subgroups of community-dwelling adults with severe care needs based on patterns of medical and long-term care (LTC) service use and to examine associations with caregiver burden.

We conducted a cross-sectional survey in four municipalities of Ibaraki Prefecture in Japan, targeting dyads of care managers and primary caregivers of adults with care-need level ≥3 living at home. Latent class analysis (LCA) was applied to service-use indicators from care manager questionnaires. Then, caregiver questionnaires were linked to assess high caregiver burden, defined by the Burden Index of Caregivers-11 (BIC-11) and dichotomized at the median. Additional analyses examined five BIC-11 domains (time-dependent, emotional, existential, physical, service-related). Adjusted prevalence ratios (aPRs) were estimated using modified Poisson regression with robust variance, adjusting for patient and caregiver covariates.

Of 320 care manager respondents, LCA identified three subtypes: (1) outpatient/day services–centered, (2) multi-component home-visit services (mainly physician and nurse home visits), and (3) outpatient/day rehabilitation–centered. After linkage and exclusion of missing data, 243 dyads were analyzed. Compared with the outpatient/day services subtype, the multi-component home-visit subtype was associated with a lower prevalence of high caregiver burden (aPR 0.66; 95% CI 0.46–0.95). Domain-specific analyses showed significantly lower emotional and existential burden in this group.

Among adults with severe care needs at home, a multi-component home-visit service pattern was associated with lower caregiver burden, suggesting that appropriate service combinations may help mitigate caregiver strain.