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For its second decade, Taiwan's National 10‐Year Long‐Term Care Plan launched a policy of reinforcing home‐ and community‐based services (HCBSs) with a focus on reablement. This study aimed to (1) identify the distinct service use patterns of reablement‐embedded HCBS and (2) examine the effects of these service patterns on functional improvements among older care recipients, including among groups with different levels of care needs. We collected 2018 data from the Long‐Term Care Service Management System for care recipients in one county located in central Taiwan (N = 4735). Three recipient groups were assigned based on level of care needs. We included data on use of the following services: reablement, home care, respite care, applications for assistive devices and home environmental modifications, transportation to medical appointments and community‐based services. Outcome variables were measured by change scores between successive assessments of activities of daily living (ADL) and instrumental activities of daily living (IADL). Latent class analysis and multivariate linear regression analyses were used to analyse relationships between use patterns, participant subgroups and outcomes. Four subgroups of HCBS use patterns were found. Care recipients with low care needs had greater potential to improve their physical function in ADL through reablement‐embedded HCBS. Care recipients in the groups with low and high care needs showed overall benefits in functional improvements in ADL and IADL from personal care–based HCBS. Care recipients in the community‐based and multiple services–based use pattern subgroups showed the least improvement in physical function. Our study indicates that the effects of reablement‐embedded HCBS use strategies may vary among older adults with different levels of care needs. We recommend further research to examine how to design HCBS with a reablement focus to better fit the needs of those with moderate and high levels of care needs. [ABSTRACT FROM AUTHOR]

Highlights • Three disability trajectories were found in middle-old and older adults in Taiwan. • Disability trajectories mediated the effects of sociodemographics on service use. • Prevention in developing a fast-growing disability trajectory should be noted. • Education had opposing effects on the use of healthcare and long-term care services. Abstract Objectives To understand whether disability trajectories mediated the association between sociodemographic characteristics and later health care and long-term care services use. Methods Data were from the Taiwan Longitudinal Study on Aging Survey, 1996–2007 (N =3429). Latent class growth curves modeling and structural equation modeling were applied to examine the effect of disability trajectory as mediator on sociodemographic characteristics and on later services use. Results Respondents were identified in three trajectories: maintained disability (1.92%), progressive disability (10.56%), and functional independence trajectories (87.52%). The progressive disability trajectory partially and fully mediated the effects of age on later use of health care and long-term care services (the partially mediating effect on age and long-term care service use: β = 0.047, p < 0.001, for example). With the progressive disability trajectory in the model, higher education had a direct effect on greater use of long-term care services (β = 0.020, p =0.020), but through the mediating effect of the disability trajectory, education had an indirect effect on lower use of long-term care services(β = -0.025, p < 0.001). Education had fully mediating effects on the later use of inpatient (β = -0.016, p < 0.001) and emergency services (β= -0.012, p < 0.001). Conclusions Preventing older adults from developing a fast-growing disability trajectory could be an effective way to decrease use of health care and long-term care services and related expenditures in late life. [ABSTRACT FROM AUTHOR]

This study had two aims: (a) to identify the different patterns of use of home- and community-based services (HCBS) among older adults in Taiwan, and (b) to examine the effects of the different use patterns on HCBS recipients' use of institutional long-term care services. The study analyzed cohort data from Taiwan's first National 10-Year Long-Term Care Plan database and from National Health Insurance Claim Data. We extracted baseline information on older adults who were first evaluated for and prescribed HCBS from 2010 through 2013 (N = 71,260). We used latent class analysis to specify the underlying subgroups of recipients with similar patterns of HCBS use. We used hierarchical multinomial logistic regression to examine the effect of the different use patterns on the risk of institutional (e.g., nursing home) placement from 4 to 15 months after initial HCBS evaluation. Four subgroups of HCBS recipients were identified, with patterns of home-based personal care (PC), home-based personal care and medical care (PC/MC), home-based medical care (MC), and community care services. Compared to the home-based PC/MC group, people in the home-based MC group had lower risk (OR = 0.54) and people in the community care group had higher risk (OR = 1.76) of admission to a nursing home. Study findings may provide insights for policy makers regarding the usefulness of integrating medical care and other types of long-term care services into adult day care. • Four subgroups of HCBS service patterns were identified. • The home-based medical care use pattern appears to support aging in place. • Integrate medical care and other long-term care services into community-based care. [ABSTRACT FROM AUTHOR]

Background: Reablement is a philosophy of change in long-term care (LTC). Assessing the knowledge and competence of LTC professionals who provide reablement services is vital in LTC research. This study aimed to develop a scale for the assessment of long-term care reablement literacy (LTCRL) and employ this scale to assess the performance of home care workers in Taiwan.Methods: To develop this scale, we employed the modified Delphi technique based on the theoretical framework of health literacy and the content of service delivery in reablement. Home care workers from northern, central, and southern Taiwan were selected through purposive sampling (N = 119). Participants answered a self-administered questionnaire that included items related to basic demographic characteristics and questions to assess LTCRL.Results: Based on the experts' consensus on the procedure of the modified Delphi technique, the LTCRL assessment sale consists of 29 questions on four aspects of knowledge acquisition: the abilities to access/obtain, understand, process/appraise, and apply/use. The results revealed that higher education levels and better Chinese language proficiency are associated with higher LTCRL outcomes among home care workers.Conclusions: The LTCRL assessment scale based on a modified Delphi technique is useful and feasible for evaluating LTCRL in home care workers who provide reablement services in Taiwan. [ABSTRACT FROM AUTHOR]