Discrepancies in Necessary Support for Long-Term Care From Perspective of Patient's Family in Japan

Friday, 28 July 2017

Tomoko Ito, PhD
Department of Health Services Research, University of Tsukuba, Tsukuba, Japan

Purpose: Cerebrovascular disease is the primary reason to need long-term care in Japan, and family caregiver will face their caregiving at home with uncertainty (Byun, Riegel, Sommers, Tkacs, & Evans, 2016) or burden (Camak, 2015). At patient discharging, support for family caregiver has come general, however, its quality has not been sufficiently controlled yet (Lutz, Young, Creasy, Martz, Eisenbrandt, Brunny, & Cook, 2016). This study aim was to find family caregiver’s own requests for support by interview survey at 1 year later than their patients’ discharge and to discuss for clinical discrepancy between actual and ideal support.

Methods: This study was conducted at one hospital located in northern Kanto field of Japan. This hospital is a general hospital that advocates over 30 departments, and it is an acute care hospital for tertiary emergency care. Study subjects were family caregivers of whom patients were collected with inclusion criterion as following, 1. Diagnosed as cerebral infarction or atraumatic intracranial hematoma; 2. Discharged at 1 year ago; 3. Age at admission was 40 or more; 4. Modified ranking scale at discharge was 3, 4, or 5. The final criteria for collection was to be stable in their symptom and physician allowed their participation. In the interview survey, researchers visited the subjects for whom the consent of research participation was obtained, and asked questions including structured and unstructured items. This study was approved by the ethical review board of the field hospital.

Results: We found six respondents who had informed and consent. There were three males who were husband of patients. Among three females, the relationships to patients were wife in 2 cases and daughter. In the one case, a subject lost the patient. They showed their requests for support at discharge including advice about financial supports or utilization of long-term care services. One said “I had known nothing about long-term care. Completely I relied on social worker or care manager, but their support was never enough. They never told us what we wanted.”

Conclusion: We found comments meaning clinical discrepancies in necessary support for long-term care through interviews for family caregivers. At that time to be family caregiver, they were concerned only “I do not know,” but in retrospect, they made feelings closed to the indignation of “why did not you tell me.” This feeling seemed to be appeared after a certain period (more than 1 year in this study) from injury. It was suggested the assessment for problems among family caregivers was needed with estimation for their future caring.