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A Survey on Changes in Long-Term Care Service Utilization Among Individuals With Dementia During the COVID-19
Kenta Hirohama1,2, Hungu Jung1, Yuji Iwamoto1,3
1Department of Medicine for Integrated Approach to Social Inclusion, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Aim:
During the COVID-19 pandemic, long-term care (LTC) providers limited services, and many persons with dementia (PWDs) avoided contact. This study examined whether reduced service use was driven primarily by provider-imposed restrictions or user concerns about infection.
Methods:
A cross-sectional survey was conducted in Japan (January-February 2023) among 436 care managers to assess changes in operations, user intentions, and living conditions of PWDs. Hierarchical logistic regression identified predictors of reduced use, and structural equation modeling (SEM) explored associations among provider/user factors, service utilization, and living conditions.
Results:
Among respondents, 58% reported decreased service use. Facility closures (odds ratio [OR] = 1.68), users' desire to discontinue services (OR = 2.35), and cancellations of short-term stays (OR = 2.58) were significantly associated with reduced utilization. User-related factors had a greater impact than provider-related ones. The SEM showed good fit (non-significant chi-square, acceptable indices). Reduced service use was linked to worsening daily life for PWDs; in 89% of affected cases, patients relied on family care, often leading to increased caregiver burden.
Conclusions:
User-initiated service avoidance, compounded by provider restrictions, contributed to decreased LTC use and worsened outcomes for PWDs. Policy responses should strengthen flexible home- and community-based services and provide enhanced caregiver support to ensure care continuity during future public health crises.
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