ATTITUDES TOWARD USE OF NURSING-HOMES AND HOME CARE IN OLDER JAPANESE-AMERICANS

OBJECTIVE: A cohort of 1142 older Japanese Americans was identified to study preferences and attitudes regarding use of long-term care (nurs ing home or home care). DESIGN: Prospective cohort study. PARTICIPANTS AND SETTING: Older Japanese Americans in King County, Washington.RESU LTS: Subjects were asked to consider hypothetical situations in which they were temporarily disabled by hip fracture or permanently disabled by dementing illness. If they fractured a hip, only 12% intended to u se a nursing home; 29% intended to recover at home with the help of fa mily or friends; another 54% intended to use paid home health care. If they became demented, the majority (53%) intended to use a nursing ho me; only 11% intended to rely on family or friends for care, and anoth er 29% intended to use paid home health care. Similar responses were o bserved when subjects were asked what most members of their family or friends would wish them to do; however, they tended to value the perce ived wishes of religious figures or the Japanese American community-at -large less than those of family or friends. Significant correlates wi th intention to enter nursing homes were lack of social support (unmar ried, few or no close relatives or housemates), female gender, and hig h levels of acculturation into American society (never lived in Japan, English-speaking only). Other factors that were not significantly cor related were health perceptions, satisfaction and life control scales, and health care utilization (hospitalizations and MD visits). In mult ivariate logistic regression, marital status and level of acculturatio n were the most powerful independent predictors of intention to enter nursing homes. Age and female gender were predictors of intention to u se home care. In the base population of subjects, the prevalence of nu rsing homes use (5%) was similar to that of the general US older popul ation. CONCLUSIONS: We conclude that older Japanese Americans in the P acific Northwest often intend to enter nursing homes if they became di sabled by dementing illness. Actual use is similar to other older popu lations. This may be attributable largely to the existence of an ethni cally appropriate nursing home which is strongly supported by, and fam iliar to, this close-knit community. Intention to use long-term care s ervices appears to be dependent primarily on the level of social suppo rts and acculturation into American society.