This study examined the differences in the preference for long-term care (LTC) by age, period and cohort (A-P-C) in Japanese older adults through repeated cross-sectional surveys from 1998 – before the establishment of LTC insurance – to 2016, in a suburban city of metropolitan Tokyo. We analysed the direct effects of A-P-C on the preference for LTC, as well as the interaction effects of A-P-C on preference by gender, family structure and activities of daily living. Data were obtained at six time-points using repeated cross-sectional surveys for people aged 65 and older; surveys were conducted in 1998, 2002, 2004, 2010, 2013 and 2016. The preference for LTC was composed of three categories: informal care, community LTC services (CLTCS) and institutional LTC services (ILTCS). The cross-classified random-effect model was used to specify A-P-C effects. Informal care, CLITCS, ILTCS and other/no answer composed 35, 23, 33 and 9 per cent of preferences, respectively. In terms of the period effect, while there was an increase in levels of preference for CLTC between 1998 and 2010 as compared to informal care, the levels of preference were almost identical after 2010. In terms of the age effect, younger participants were more likely to prefer CLTCS and ILTCS over informal care. Moreover, the age influence was stronger in females and respondents who lived alone. We did not observe a cohort effect for preference. This study suggests that there are gaps by period and age between the preference for LTC services and the actual LTC use in Japanese older adults, and as a result, the use of actual LTC services cannot fully reflect the intentions and preference for LTC in them.

This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study’s analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.

Long-term care in Canada is situated within a universally accessible publicly insured program. The Government of Canada establishes certain minimum standards for health care as the basis for the federal share in funding health programs, although the programs themselves are administered provincially. Examples are drawn from the Province of Manitoba. While the dependency ratio has been decreasing due to a slower increase in the number of persons under 17 years of age, the percent of the population over 65 years continues to increase. Population projections forecast that by the year 2031, one-quarter of the population of Canada will be over 65 years of age. Expenditures on health care doubled from 1981 to 1990 for both Manitoba and Canada. The policy response to ever-increasing costs of delivering health care to an aging population has been to seek alternative methods of delivery. Specifically, the long-term care bed-to-population ratio has been reduced and the authors anticipate continued modest increases in the use of community care.