Actual situation and characteristics of clients judged to need home-visiting nurse services by certified care managers and comparison of users and non-users of such services

Objectives To investigate the actual situation and characteristics of clients judged to need home-visit nurse services (HN) by certified care managers and to compare the characteristics of users of HN to those of non-users of HN, so that appropriate use of HN can be encouraged. Methods The participants were all certified care managers working at 57 care management offices in 4 cities in prefecture A. They were asked to fill out questionnaires for each of their clients whose degree of care was 2 or greater between November 2005 and February 2006. The items in the questionnaire included client's age, sex, degree of care, level of activity of daily living (ADL), dementia level, presence of a caregiver, necessity of HN, the actual use of HN. The dependent variables for analysis (univariate analysis and logistic regression) were the necessity of HN, and the actual use of HN among the clients needing HN. Results Forty care management offices (70.2%) responded to our survey and the number of filled questionnaires was 1,288, providing a final sample of 1,224 clients. Care managers judged 537 clients as needing HN, and 328 actually used HN. The clients who needed HN were younger and more dependent for ADL, and had more severe care degree, higher rates of medical treatment, neurological disease, hospitalization during the previous 6 months, no cohabiter, no caregiver, anda caregiver aged 75 years or more, than the clients who did not need HN. Among the clients who were judged as needing HN by the care managers, the actual users were only 59.0% and these had higher rates of medical treatment and a dementia level of 1 or no dementia than non-users. Conclusion Of the clients who were judged as needing HN by the care managers, only 59.0% used HN. The necessity of HN was related to many variables such as medical condition and status of the caregiver. The actual users tended to be dependent for ADL and to need medical treatment, and moderately or severely demented clients were not likely to use HN. The reasons why some clients did not use HN despite necessity might be the lack of knowledge or cognition, and competition with other services. Strategies for encouraging use of HN should be developed.