JMIR Publications

ABSTRACT

Background:

Japan is facing a super-aging society, unparalleled by the world. As a new service to address this issue, a small-scale multifunctional in-home care nursing service called “Kantaki” was created in 2012. Kantaki, in collaboration with a primary physician, provides various nursing services (home visits, home care, daycare, and overnight stay) 24 hours a day to older people living in the community. The Japanese nursing association is working hard to promote this system; however, its low utilization rate is an issue.

Objective:

This study aimed to determine the factors influencing the utilization rate of Kantaki facilities.

Methods:

This was a cross-sectional study. A questionnaire on the operation of Kantaki was sent to all administrators of Kantaki facilities operating in Japan from October 1 to December 31, 2020. A multiple regression analysis was used to determine the factors associated with an increased utilization rate.

Results:

Responses from 154 of the 593 facilities were analyzed. The average utilization rate for all valid responding facilities was 79.4%. The average number of actual users was more (21.1) than the average break-even point (20.9, the point at which revenues exceeded costs) with little difference. On multiple regression analysis, the break-even point, surplus of users relative to the break-even point (margin of revenues), number of months in office as an administrator, type of corporation (non-profit), and Kantaki’s profit from operating home-visit nursing offices had a significant impact on the utilization rate. Among others, the break-even point, surplus of users relative to the break-even point, and number of months in office as an administrator were robust. In addition, support for reducing the burden on family helpers, a service sought by the system, significantly and negatively affected the utilization rate. In the analysis that removed the most influential factors, the co-operation of the home-visit nursing office, Kantaki’s profit from operating the home-visit nursing office, and the number of full-time care workers were significantly related.

Conclusions:

To improve the utilization rate, managers need to stabilize their organization and increase profitability. A positive relationship was found between the breakeven point and utilization rate, suggesting that simply increasing users did not contribute to cost reduction. Moreover, providing services that meet the needs of individual clients may result in lower utilization rates. To solve these issues, institutional reforms, such as an increase in nursing care fee points, were considered necessary.